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doctor: okay so there is decreased flexion and extension of the right knee there is associated ecchymosis to the right medial knee there is no evidence of an effusion okay so billy what does all of that mean that means that you just have signs of that you have a little bit of an upper respiratory infection that might have caused some congestion in your in your lungs which we will talk about okay and then and as far as your knee exam it just shows that you do have some inflammation and some evidence that you had injured it earlier so let's just talk a little bit about you know my assessment and my plan for you for all of these issues okay so for your first problem of your cough you know i do believe that you just have a a viral syndrome at this time you probably have some mild bronchitis i really just wan na go ahead and just you know recommend some supportive care you can continue to take over the counter medications we can prescribe guaifenesin six hundred six hundred milligrams twice a day to help cough up some of that phlegm and i do n't think you need need any antibiotics at this time but certainly if your symptoms worsen i want you to call me and then we can go ahead and consider ordering a chest x-ray to make sure that you do n't have any pneumonia okay how does that sound patient: that sounds good
D2N199
37
[ "Physical Examination", "Discussion", "Medication", "Diagnostic Testing", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay so there is decreased flexion and extension of the right knee there is associated ecchymosis to the right medial knee there is no evidence of an effusion okay so billy what does all of that mean that means that you just have signs of that you have a little bit of an upper respiratory infection that might have caused some congestion in your in your lungs which we will talk about okay and then and as far as your knee exam it just shows that you do have some inflammation and some evidence that you had injured it earlier so let's just talk a little bit about you know my assessment and my plan for you for all of these issues okay so for your first problem of your cough you know i do believe that you just have a a viral syndrome at this time you probably have some mild bronchitis i really just wan na go ahead and just you know recommend some supportive care you can continue to take over the counter medications we can prescribe guaifenesin six hundred six hundred milligrams twice a day to help cough up some of that phlegm and i do n't think you need need any antibiotics at this time but certainly if your symptoms worsen i want you to call me and then we can go ahead and consider ordering a chest x-ray to make sure that you do n't have any pneumonia okay how does that sound
5,100
doctor: okay so for your second problem of your right knee pain i do believe you have a a a right medial collateral ligament strain from the fall this morning and i really wan na just go ahead and and i'll prescribe some meloxicam fifteen milligrams once a day and we can refer you to physical therapy to help strengthen those muscles around that area and i'm gon na go ahead and just order a right knee x-ray just to make sure that you did n't injure any bones although i do n't think you did but we'll just go ahead and order that right knee x-ray how does that sound patient: okay that sounds like good good plan
D2N199
38
[ "Medication", "Diagnostic Testing", "Reassessment" ]
[ "Assessment", "Plan" ]
okay so for your second problem of your right knee pain i do believe you have a a a right medial collateral ligament strain from the fall this morning and i really wan na just go ahead and and i'll prescribe some meloxicam fifteen milligrams once a day and we can refer you to physical therapy to help strengthen those muscles around that area and i'm gon na go ahead and just order a right knee x-ray just to make sure that you did n't injure any bones although i do n't think you did but we'll just go ahead and order that right knee x-ray how does that sound
5,101
doctor: okay and then for your third problem of your hypertension let's just continue on the lisinopril twenty milligrams a day i wan na go ahead and order a lipid panel to make sure everything is okay from that standpoint and lastly your fourth problem your diabetes i wan na go ahead and order a hemoglobin a1c just to make sure we do n't have to make any adjustments to your metformin and i really want you to try to monitor your sugar intake and report your blood sugars to me through the patient portal how does that sound patient: okay i'll try that i try my best
D2N199
39
[ "Medication", "Diagnostic Testing", "Reassessment" ]
[ "Assessment", "Plan" ]
okay and then for your third problem of your hypertension let's just continue on the lisinopril twenty milligrams a day i wan na go ahead and order a lipid panel to make sure everything is okay from that standpoint and lastly your fourth problem your diabetes i wan na go ahead and order a hemoglobin a1c just to make sure we do n't have to make any adjustments to your metformin and i really want you to try to monitor your sugar intake and report your blood sugars to me through the patient portal how does that sound
5,102
doctor: alright that sounds good i'll i'll be in touch with you with those results okay patient: okay appreciate it
D2N199
40
[ "Chitchat" ]
[ "Null" ]
alright that sounds good i'll i'll be in touch with you with those results okay
5,103
doctor: alright take care bye
D2N199
41
[ "Chitchat" ]
[ "Null" ]
doctor: alright take care bye
5,104
doctor: alright okay theresa so i understand that you're you're having a bit of some headache here and then your blood pressure has been running high can you tell me a little bit about what's happening patient: yeah i've had blood high blood pressure for a long time my provider gave me chlorthalidone i do n't really take it because it gives me a stomachache but yeah i get headaches right here on the top of my head they kinda come and go they're throbbing tylenol helps the headache
D2N200
0
[ "Acute Symptoms", "Personal History", "Greetings" ]
[ "Subjective" ]
alright okay theresa so i understand that you're you're having a bit of some headache here and then your blood pressure has been running high can you tell me a little bit about what's happening
5,105
doctor: okay alright and then so how long have you had this headache has this been recent or like acute or you've been having this for since you've had your blood pressures patient: hmmm it's been on and off for about a month
D2N200
1
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
okay alright and then so how long have you had this headache has this been recent or like acute or you've been having this for since you've had your blood pressures
5,106
doctor: a month okay alright and then are you having any other kind of symptoms with that like are you having any kind of you know dizziness lightheadedness any nausea vomiting patient: yeah sometimes i feel dizzy and my vision gets a little blurry
D2N200
2
[ "Vegetative History" ]
[ "Subjective" ]
a month okay alright and then are you having any other kind of symptoms with that like are you having any kind of you know dizziness lightheadedness any nausea vomiting
5,107
doctor: okay alright how about like chest pain or shortness of breath are you experiencing any of that when you have these headaches in your blood pressure patient: chest pain or shortness of breath
D2N200
3
[ "Vegetative History" ]
[ "Subjective" ]
okay alright how about like chest pain or shortness of breath are you experiencing any of that when you have these headaches in your blood pressure
5,108
doctor: okay very good alright and then you said you were you've taken some tylenol for that and you said it did help a little bit or did n't sorry patient: it does help
D2N200
4
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay very good alright and then you said you were you've taken some tylenol for that and you said it did help a little bit or did n't sorry
5,109
doctor: it does help good very good so how often are you taking your your medication are you taking that as prescribed like daily it sounds like you missed a few times but for the most part are you taking it patient: yeah i forget a lot so i probably take it like every other day
D2N200
5
[ "Therapeutic History" ]
[ "Subjective" ]
it does help good very good so how often are you taking your your medication are you taking that as prescribed like daily it sounds like you missed a few times but for the most part are you taking it
5,110
doctor: okay every other day alright and then are you also now i know you also have some diabetes so are you how are you doing with that one are you pretty much taking your metformin everyday patient: hmmm i probably take it when i take my other medicine like every other day
D2N200
6
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay every other day alright and then are you also now i know you also have some diabetes so are you how are you doing with that one are you pretty much taking your metformin everyday
5,111
doctor: every other day okay so i do see that you know the nurse took your your vital signs this morning that your blood pressure is running quite a bit high it was like one seventy two over ninety eight so that's that's really a little higher than where we want it to be especially that you're on your medication but what we're gon na do is we're gon na take i'm gon na take a look at you real quick and then we can discuss you know maybe there's some changes that we can do in terms of your current regimen how about diet and your have you been sticking with that low sodium diet at all patient: no i love mcdonald's i eat it all the time
D2N200
7
[ "Physical Examination", "Personal History" ]
[ "Subjective", "Objective" ]
every other day okay so i do see that you know the nurse took your your vital signs this morning that your blood pressure is running quite a bit high it was like one seventy two over ninety eight so that's that's really a little higher than where we want it to be especially that you're on your medication but what we're gon na do is we're gon na take i'm gon na take a look at you real quick and then we can discuss you know maybe there's some changes that we can do in terms of your current regimen how about diet and your have you been sticking with that low sodium diet at all
5,112
doctor: i love mcdonald's too my favorite is big mac i do n't know about you but i got ta have my big mac with those large fries which you what's your favorite mcdonald's treat there patient: i need to think of what fully of fish i love flare of fish
D2N200
8
[ "Vegetative History" ]
[ "Subjective" ]
i love mcdonald's too my favorite is big mac i do n't know about you but i got ta have my big mac with those large fries which you what's your favorite mcdonald's treat there
5,113
doctor: well at least you're eating the fish but but they can be very high in sodium especially the fast foods so we'll have to talk about maybe they can look at you know some some diet changes as well so the other thing is for your for your blood sugar here i see that you know you're running a bit high as well it looks like you're like you're about one seventy this morning and i i i i assume that you were fasting last night is that right okay so that's that's a little higher than what we want it's not bad it's below two hundred but it's getting kinda close to the borderline from where our limit is so we will take we take a look at that and also we'll figure out what we can do with that as well alright so at this point how about are you how is how is work how is life it's been good otherwise how's the family patient: they are good i did eat a lot of my kids easter candy over the weekend so maybe that's why my sugar is high
D2N200
9
[ "Other Socials" ]
[ "Subjective" ]
well at least you're eating the fish but but they can be very high in sodium especially the fast foods so we'll have to talk about maybe they can look at you know some some diet changes as well so the other thing is for your for your blood sugar here i see that you know you're running a bit high as well it looks like you're like you're about one seventy this morning and i i i i assume that you were fasting last night is that right okay so that's that's a little higher than what we want it's not bad it's below two hundred but it's getting kinda close to the borderline from where our limit is so we will take we take a look at that and also we'll figure out what we can do with that as well alright so at this point how about are you how is how is work how is life it's been good otherwise how's the family
5,114
doctor: okay alright great alright alright just just around easter okay not not too much during the the year hopefully patient: yeah i try
D2N200
10
[ "Other Socials" ]
[ "Subjective" ]
okay alright great alright alright just just around easter okay not not too much during the the year hopefully
5,115
doctor: well that's good so let's go ahead and do a physical exam on you real quick here okay and so i'm looking at your vital signs it looks like your blood pressure i we mentioned that today is pretty high your heart rate looks good it's with it's within normal limits here and then your oxygenation is fine so you did mention you did n't have any shortness of breath so that's good so let me just feel around your neck real quick here i do n't appreciate any jugular venous distention on your neck exam i no carotid bruits so that's good let me go ahead and listen to your lungs and your heart here real quick alright so on your auscultation of your lungs they're clear bilaterally on your heart exam though i i do sense a two out of six systolic ejection murmur now that was also there last year so it has n't changed any so we'll just keep monitoring that one and then let me take a look at your extremities here real quick theresa so let me look at your hands you got a little bit of slight edema bilaterally on your upper extremities but let me look at your legs here okay so you have a one plus pitting edema noted here on your legs bilaterally so that means you're retaining a lot of that salt that you're eating unfortunately okay so so let me go ahead and tell you about my assessment and plan here so definitely what you're experiencing is some uncontrolled hypertension now most of the time you know it's multifactorial right it's your diet it could be the medication regimen if you're not following that and then it might be that we are gon na need to change the medication around and also change your diet but i would like to start with going ahead and i want to continue your current medication regimen today i do wan na really encourage that you do take that everyday maybe set a reminder like on your you know do you use your iphone a lot for your reminders and things maybe we can go ahead and do that get a reminder make sure that you take that everyday but with that i would like to go ahead and also monitor your blood pressure let's do it three times a week it can be much when we do it everyday but maybe three times a week do you have a blood pressure monitor at home patient: no
D2N200
11
[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Other Treatments", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
well that's good so let's go ahead and do a physical exam on you real quick here okay and so i'm looking at your vital signs it looks like your blood pressure i we mentioned that today is pretty high your heart rate looks good it's with it's within normal limits here and then your oxygenation is fine so you did mention you did n't have any shortness of breath so that's good so let me just feel around your neck real quick here i do n't appreciate any jugular venous distention on your neck exam i no carotid bruits so that's good let me go ahead and listen to your lungs and your heart here real quick alright so on your auscultation of your lungs they're clear bilaterally on your heart exam though i i do sense a two out of six systolic ejection murmur now that was also there last year so it has n't changed any so we'll just keep monitoring that one and then let me take a look at your extremities here real quick theresa so let me look at your hands you got a little bit of slight edema bilaterally on your upper extremities but let me look at your legs here okay so you have a one plus pitting edema noted here on your legs bilaterally so that means you're retaining a lot of that salt that you're eating unfortunately okay so so let me go ahead and tell you about my assessment and plan here so definitely what you're experiencing is some uncontrolled hypertension now most of the time you know it's multifactorial right it's your diet it could be the medication regimen if you're not following that and then it might be that we are gon na need to change the medication around and also change your diet but i would like to start with going ahead and i want to continue your current medication regimen today i do wan na really encourage that you do take that everyday maybe set a reminder like on your you know do you use your iphone a lot for your reminders and things maybe we can go ahead and do that get a reminder make sure that you take that everyday but with that i would like to go ahead and also monitor your blood pressure let's do it three times a week it can be much when we do it everyday but maybe three times a week do you have a blood pressure monitor at home
5,116
doctor: okay so i can recommend some really good ones nowadays that you can use at home and they're not that expensive and at least it'll give you some you know idea of what your blood pressure is running at and then i want you to come back like in a month because i wan na go ahead and see how your blood pressure is doing now that you know you're you you're taking your blood pressure medication everyday the other thing is i do wan na go ahead and have a nutritionist come and talk to you about you may maybe some dietary changes i'd like for you to start a – diet it's really to to help you know a lot of reduce a lot of that sodium intake when you're when you're when you're taking in your food so a nutritionist is gon na be able to help you figure out some foods that you know that you may like that you can actually use as an alternative besides the mcdonald's although you can have that once in a blue moon but you know not not too often okay patient: okay sounds good
D2N200
12
[ "Discussion", "Referral", "Medication", "Other Treatments" ]
[ "Plan" ]
okay so i can recommend some really good ones nowadays that you can use at home and they're not that expensive and at least it'll give you some you know idea of what your blood pressure is running at and then i want you to come back like in a month because i wan na go ahead and see how your blood pressure is doing now that you know you're you you're taking your blood pressure medication everyday the other thing is i do wan na go ahead and have a nutritionist come and talk to you about you may maybe some dietary changes i'd like for you to start a – diet it's really to to help you know a lot of reduce a lot of that sodium intake when you're when you're when you're taking in your food so a nutritionist is gon na be able to help you figure out some foods that you know that you may like that you can actually use as an alternative besides the mcdonald's although you can have that once in a blue moon but you know not not too often okay
5,117
doctor: great and then for your diabetes i wan na go ahead and let's go ahead and increase your your metformin to fifteen hundred milligrams i think all for that too i want you to go ahead and continue taking your blood sugars to make sure as as you normally would to make sure that you know that change in medication is is actually being effective alright do you have any other questions for me at this time patient: nope
D2N200
13
[ "Discussion", "Medication", "Reassessment" ]
[ "Assessment", "Plan" ]
great and then for your diabetes i wan na go ahead and let's go ahead and increase your your metformin to fifteen hundred milligrams i think all for that too i want you to go ahead and continue taking your blood sugars to make sure as as you normally would to make sure that you know that change in medication is is actually being effective alright do you have any other questions for me at this time
5,118
doctor: okay great well i'm gon na have the nurse check you out and and i'll have the scheduler schedule you for a one month follow-up we'll take a look and see how you're doing from there see if we have then we will move from there okay patient: sounds good thank you
D2N200
14
[ "Follow-up" ]
[ "Plan" ]
okay great well i'm gon na have the nurse check you out and and i'll have the scheduler schedule you for a one month follow-up we'll take a look and see how you're doing from there see if we have then we will move from there okay
5,119
doctor: thanks theresa
D2N200
15
[ "Chitchat" ]
[ "Null" ]
doctor: thanks theresa
5,120
doctor: hey steven so i see that you're here and you've been experiencing some back pain for a while could you tell me a bit about that patient: yeah it's been back has been hurting for a while
D2N201
0
[ "Greetings", "Acute Symptoms" ]
[ "Subjective" ]
hey steven so i see that you're here and you've been experiencing some back pain for a while could you tell me a bit about that
5,121
doctor: mm-hmm patient: for about a couple of years and tried a couple things but nothing seems to work
D2N201
1
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm
5,122
doctor: okay so let's start start with what happened did something cause the pain patient: i think well i played basketball and i bumped one time and i fell and i hit i think i fell on my back got fell real hard
D2N201
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay so let's start start with what happened did something cause the pain
5,123
doctor: mm-hmm patient: so it's been hurting after ever since that
D2N201
3
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm
5,124
doctor: okay and then how severe is the pain on a scale of like one to ten patient: i think it's around a seven
D2N201
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and then how severe is the pain on a scale of like one to ten
5,125
doctor: wow okay could you describe it for me is it like sharp is it throbbing patient: it it hurts pretty bad it's it's sharp
D2N201
5
[ "Acute Symptoms" ]
[ "Subjective" ]
wow okay could you describe it for me is it like sharp is it throbbing
5,126
doctor: and does it radiate patient: sometimes it hurts more than others and i'm not sure why
D2N201
7
[ "Vegetative History" ]
[ "Subjective" ]
and does it radiate
5,127
doctor: and does it radiate anywhere patient: yeah it goes down my leg my left leg
D2N201
8
[ "Vegetative History" ]
[ "Subjective" ]
and does it radiate anywhere
5,128
doctor: okay alright patient: like my toes get numb a little sometimes
D2N201
9
[ "Vegetative History" ]
[ "Subjective" ]
okay alright
5,129
doctor: wow okay and how about like so hmmm you said it goes down your left leg how about any like are you experiencing any loss of sensation in like the genital or rectal area patient: i hope not
D2N201
10
[ "Vegetative History" ]
[ "Subjective" ]
wow okay and how about like so hmmm you said it goes down your left leg how about any like are you experiencing any loss of sensation in like the genital or rectal area
5,130
doctor: that's okay i i it's gon na help me isolate like what's what exactly is going on so please do n't feel embarrassed to answer the questions do you have any weakness patient: yeah sometimes i try to stand up and and and like i i ca n't go get weak or if i'm standing up for too long
D2N201
11
[ "Vegetative History" ]
[ "Subjective" ]
that's okay i i it's gon na help me isolate like what's what exactly is going on so please do n't feel embarrassed to answer the questions do you have any weakness
5,131
doctor: okay so would you would you say that there are certain positions that make you feel better or worse patient: yeah like lying on my side makes me feel better
D2N201
12
[ "Acute Symptoms" ]
[ "Subjective" ]
okay so would you would you say that there are certain positions that make you feel better or worse
5,132
doctor: and then you said that standing also makes it worse right patient: yeah if i stand for a while
D2N201
14
[ "Acute Symptoms" ]
[ "Subjective" ]
and then you said that standing also makes it worse right
5,133
doctor: okay and then have you experienced any like loss of control of like your bladder or your bowels patient: yeah i pooped myself once
D2N201
15
[ "Vegetative History" ]
[ "Subjective" ]
okay and then have you experienced any like loss of control of like your bladder or your bowels
5,134
doctor: okay so incontinence just once though like over the last two years right it's not like a consistent thing patient: no it's not consistent i think i stood up for too long i think i was drinking too
D2N201
16
[ "Vegetative History" ]
[ "Subjective" ]
okay so incontinence just once though like over the last two years right it's not like a consistent thing
5,135
doctor: okay okay you mentioned earlier that you tried some things in the past like what were they patient: so i i had a doc gave me some injections before i'm not sure what they were though
D2N201
17
[ "Therapeutic History" ]
[ "Subjective" ]
okay okay you mentioned earlier that you tried some things in the past like what were they
5,136
doctor: okay alright and i see in your chart here that you had physical therapy did you feel that that was effective patient: no i feel like i could do them the same exercises at my house like they charged me and like it
D2N201
18
[ "Personal History" ]
[ "Subjective" ]
okay alright and i see in your chart here that you had physical therapy did you feel that that was effective
5,137
doctor: okay but did the did the exercises help patient: i mean i guess a little
D2N201
19
[ "Personal History" ]
[ "Subjective" ]
okay but did the did the exercises help
5,138
doctor: okay not a so not as effective as we would have liked did they put you on any pain medications patient: yeah it was just a white pill i'm not sure what it was
D2N201
20
[ "Therapeutic History" ]
[ "Subjective" ]
okay not a so not as effective as we would have liked did they put you on any pain medications
5,139
doctor: okay do n't worry i think i can look that up in your chart i just wan na make sure that we have the story straight alright so i know that you said that you mentioned that you played basketball you know before how how like what's your activity like now patient: i mean i sit at home all day
D2N201
21
[ "Other Socials" ]
[ "Subjective" ]
okay do n't worry i think i can look that up in your chart i just wan na make sure that we have the story straight alright so i know that you said that you mentioned that you played basketball you know before how how like what's your activity like now
5,140
doctor: okay that's a pretty okay that's a pretty significant weight gain well i i just have a few more questions have you do you know if any of your family members have spine conditions patient: i think my fourth cousin has scoliosis
D2N201
24
[ "Family History" ]
[ "Subjective" ]
okay that's a pretty okay that's a pretty significant weight gain well i i just have a few more questions have you do you know if any of your family members have spine conditions
5,141
doctor: okay okay but that's that's a little distant but anybody direct like sister brother mom dad patient: i do n't think so i mean i do n't even my dad though
D2N201
25
[ "Family History" ]
[ "Subjective" ]
okay okay but that's that's a little distant but anybody direct like sister brother mom dad
5,142
doctor: okay okay and then do you have a personal history of smoking patient: what type of smoking
D2N201
26
[ "Drug History" ]
[ "Subjective" ]
okay okay and then do you have a personal history of smoking
5,143
doctor: any smoke you do n't have to tell me exactly but patient: okay
D2N201
27
[ "Vegetative History" ]
[ "Subjective" ]
any smoke you do n't have to tell me exactly but
5,144
doctor: have you smoked patient: next maybe that i have n't
D2N201
28
[ "Vegetative History" ]
[ "Subjective" ]
have you smoked
5,145
doctor: are you it's okay i'm your doctor i'm not here to judge you i just want to make sure that i'm like you know when the conclusions that we come to and like my assessment and plan for you i need to know this information so one more time do you smoke or have you smoked before patient: okay i smoked
D2N201
29
[ "Vegetative History" ]
[ "Subjective" ]
are you it's okay i'm your doctor i'm not here to judge you i just want to make sure that i'm like you know when the conclusions that we come to and like my assessment and plan for you i need to know this information so one more time do you smoke or have you smoked before
5,146
doctor: okay that's fine how much and how often and what was it patient: i'm not telling you all that i'm just telling you i smoked
D2N201
30
[ "Vegetative History" ]
[ "Subjective" ]
okay that's fine how much and how often and what was it
5,147
doctor: okay you have patient: too many questions are you the fit
D2N201
31
[ "Chitchat" ]
[ "Null" ]
okay you have
5,148
doctor: i'm your doctor i have to patient: are you the fence you sound like the fence next question
D2N201
32
[ "Chitchat" ]
[ "Null" ]
i'm your doctor i have to
5,149
doctor: i'm not a op i promise alright that's fine but let me know are you currently like smoking patient: no
D2N201
33
[ "Drug History" ]
[ "Subjective" ]
i'm not a op i promise alright that's fine but let me know are you currently like smoking
5,150
doctor: okay okay i just have to ask alright so i do wan na do a quick physical exam i did review your vitals and like part of why i wan na know about your smoking history is that you are stating kind of low like it looks like you are might be in the ninety five percentile range and so we might need to explore some things patient: sent them off yeah
D2N201
34
[ "Physical Examination", "Drug History" ]
[ "Objective" ]
okay okay i just have to ask alright so i do wan na do a quick physical exam i did review your vitals and like part of why i wan na know about your smoking history is that you are stating kind of low like it looks like you are might be in the ninety five percentile range and so we might need to explore some things
5,151
doctor: pardon patient: because i'm fat my cousin was fat too and and he gained a bunch of weight he he had to have oxygen
D2N201
35
[ "Physical Examination" ]
[ "Objective" ]
pardon
5,152
doctor: you know honestly there are a few other factors weight gain does n't necessarily help you're right but like smoking has like a stronger impact so but it's okay we can explore like you know other options here i as i listen to your heart you have a regular rate and rhythm i do n't appreciate any murmur on so i'm gon na go ahead and do a back exam i do n't notice any overlying erythema or ecchymosis on your skin so no redness or bruising when i push here on your spine does that hurt okay okay so there is midline tenderness on the l4 l5 disk space with right sided lumbar paravertebral tenderness when you bend forward does it hurt patient: yeah it hurts
D2N201
36
[ "Physical Examination", "Drug History" ]
[ "Objective" ]
you know honestly there are a few other factors weight gain does n't necessarily help you're right but like smoking has like a stronger impact so but it's okay we can explore like you know other options here i as i listen to your heart you have a regular rate and rhythm i do n't appreciate any murmur on so i'm gon na go ahead and do a back exam i do n't notice any overlying erythema or ecchymosis on your skin so no redness or bruising when i push here on your spine does that hurt okay okay so there is midline tenderness on the l4 l5 disk space with right sided lumbar paravertebral tenderness when you bend forward does it hurt
5,153
doctor: okay and when you bend backward does it hurt patient: a little bit
D2N201
37
[ "Physical Examination" ]
[ "Objective" ]
okay and when you bend backward does it hurt
5,154
doctor: okay so pain with lumbar flexion and extension alright and as i raise your leg does this hurt when i raise your leg up patient: stop
D2N201
38
[ "Physical Examination" ]
[ "Objective" ]
okay so pain with lumbar flexion and extension alright and as i raise your leg does this hurt when i raise your leg up
5,155
doctor: okay so supine straight leg test positive alright just a couple more things on neurological examination there is decreased sensation to light touch at the right lateral thigh at l4 dermatome patella and achilles reflexes are symmetrical so i just wanted to make sure that i documented all of that in your chart and in a you can ask me any questions but i did look over the results of the patient: what does that mean like am i dying
D2N201
39
[ "Physical Examination" ]
[ "Objective" ]
okay so supine straight leg test positive alright just a couple more things on neurological examination there is decreased sensation to light touch at the right lateral thigh at l4 dermatome patella and achilles reflexes are symmetrical so i just wanted to make sure that i documented all of that in your chart and in a you can ask me any questions but i did look over the results of the
5,156
doctor: no no no you're not dying but i think we have i think i have a good idea of what's causing your back pain so first let's talk about the mri that you had the results show a disk desiccation a disk bulge with parison paracentral disk herniation resulting in moderate right for neural foraminal stenosis okay patient: that's a big word
D2N201
40
[ "Radiology Examination" ]
[ "Objective" ]
no no no you're not dying but i think we have i think i have a good idea of what's causing your back pain so first let's talk about the mri that you had the results show a disk desiccation a disk bulge with parison paracentral disk herniation resulting in moderate right for neural foraminal stenosis okay
5,157
doctor: those are huge words it's okay so let me tell you what like what all this means and what we're gon na do like for my assessment and plan so for your problem of chronic lumbar back pain based on your symptoms your exam and reviewing your mri that's consistent with a herniated disk at the l4 l5 with radiculopathy what this means is that one of your disks that sits between your spinal vertebrae is bulging out and this bulge is pinching on some nerves that's why you feel the tingling in your leg alright so that it's also why you felt pain when i pushed on that area so i'm gon na recommend some a spinal injection with a strong anti-inflammatory medication called a corticosteroid right i think you said that you had one before but i think this is something patient: i had to have someone hold me down i do n't like needles so do you can i take a pill i do n't want that
D2N201
41
[ "Discussion", "Medication", "Acute Assessment" ]
[ "Assessment", "Plan" ]
those are huge words it's okay so let me tell you what like what all this means and what we're gon na do like for my assessment and plan so for your problem of chronic lumbar back pain based on your symptoms your exam and reviewing your mri that's consistent with a herniated disk at the l4 l5 with radiculopathy what this means is that one of your disks that sits between your spinal vertebrae is bulging out and this bulge is pinching on some nerves that's why you feel the tingling in your leg alright so that it's also why you felt pain when i pushed on that area so i'm gon na recommend some a spinal injection with a strong anti-inflammatory medication called a corticosteroid right i think you said that you had one before but i think this is something
5,158
doctor: we could yeah we could give you something to help calm down like the anxiety i would just write you a prescription for one and you would take that maybe three hours before you came in for your appointment and then you should feel calm enough to be able to do the injection patient: okay
D2N201
42
[ "Discussion", "Medication" ]
[ "Plan" ]
we could yeah we could give you something to help calm down like the anxiety i would just write you a prescription for one and you would take that maybe three hours before you came in for your appointment and then you should feel calm enough to be able to do the injection
5,159
doctor: alright patient: can i get pain pills too
D2N201
43
[ "Discussion", "Medication" ]
[ "Plan" ]
alright
5,160
doctor: can you patient: for pain
D2N201
44
[ "Discussion", "Medication" ]
[ "Plan" ]
can you
5,161
doctor: can you get what now patient: pain pills
D2N201
45
[ "Discussion", "Medication" ]
[ "Plan" ]
can you get what now
5,162
doctor: so once i inject the cotocoid steroid in the in your spine it's gon na happen under fluoroscopy right and it's going to be it's a it's just a type of of like x-ray sorry to because i need to be very specific in where i do this injection so i say this because you should n't need anymore pain pills after we do this injection it should help with the inflammation and directly target the bulge to help you out so after this injection give it maybe a day and if you say that you're still experiencing pain then we can talk about maybe giving you pain medication but remember before you said it was n't as effective so i think this steroid shot is the best chance that we have patient: i'd say it was n't effective
D2N201
46
[ "Discussion", "Medication" ]
[ "Plan" ]
so once i inject the cotocoid steroid in the in your spine it's gon na happen under fluoroscopy right and it's going to be it's a it's just a type of of like x-ray sorry to because i need to be very specific in where i do this injection so i say this because you should n't need anymore pain pills after we do this injection it should help with the inflammation and directly target the bulge to help you out so after this injection give it maybe a day and if you say that you're still experiencing pain then we can talk about maybe giving you pain medication but remember before you said it was n't as effective so i think this steroid shot is the best chance that we have
5,163
doctor: okay sorry i i i saw that they gave you strong pain meds but remember you said the white one did you say it was effective patient: yeah i said i said the white ones i said they worked
D2N201
47
[ "Discussion", "Medication" ]
[ "Plan" ]
okay sorry i i i saw that they gave you strong pain meds but remember you said the white one did you say it was effective
5,164
doctor: okay i'm sorry so alright so maybe when let's okay so what we're still gon na do though we're gon na do the injection and then if it still hurts after that then we can explore that pain medication i do n't want you to have to consistently be on pain medication it's not necessarily like a good long term solution if after we monitor this you still are experiencing pain we are gon na try the pain meds however i would maybe recommend surgery patient: i do n't want i know
D2N201
48
[ "Discussion", "Medication", "Other Treatments" ]
[ "Plan" ]
okay i'm sorry so alright so maybe when let's okay so what we're still gon na do though we're gon na do the injection and then if it still hurts after that then we can explore that pain medication i do n't want you to have to consistently be on pain medication it's not necessarily like a good long term solution if after we monitor this you still are experiencing pain we are gon na try the pain meds however i would maybe recommend surgery
5,165
doctor: right and so this is we're just gon na try everything that we can before you know before we get to that place patient: mm-hmm
D2N201
49
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
right and so this is we're just gon na try everything that we can before you know before we get to that place
5,166
doctor: do you have any questions patient: no
D2N201
50
[ "Discussion" ]
[ "Plan" ]
do you have any questions
5,167
doctor: alright patient: when it when is it when am i having this this when do you want me to get this injection
D2N201
51
[ "Discussion" ]
[ "Plan" ]
alright
5,168
doctor: okay so you're gon na go to the front and schedule it this is a very quick and common procedure it should only take about an hour we will need to do this note like if this if this is successful we would only maybe do this four times a year so whenever at the front desk go ahead and schedule i think that mine pretty available to be able to help you with this alright any other questions patient: no
D2N201
52
[ "Discussion" ]
[ "Plan" ]
okay so you're gon na go to the front and schedule it this is a very quick and common procedure it should only take about an hour we will need to do this note like if this if this is successful we would only maybe do this four times a year so whenever at the front desk go ahead and schedule i think that mine pretty available to be able to help you with this alright any other questions
5,169
doctor: okay thank you
D2N201
53
[ "Chitchat" ]
[ "Null" ]
doctor: okay thank you
5,170
doctor: good morning sharon how you doing patient: hi i'm i'm okay today i'm having some shoulder pain
D2N202
0
[ "Greetings" ]
[ "Subjective" ]
good morning sharon how you doing
5,171
doctor: i see that i see that here in the nurse's notes it looks like you're having some right shoulder pain says here that you've guys have been remodeling your house what do you do you remember what you were doing when that right shoulder pain started patient: yeah i was up on a ladder painting and kinda reaching out and fell took a fall and kinda braced myself but i i was painting
D2N202
1
[ "Acute Symptoms" ]
[ "Subjective" ]
i see that i see that here in the nurse's notes it looks like you're having some right shoulder pain says here that you've guys have been remodeling your house what do you do you remember what you were doing when that right shoulder pain started
5,172
doctor: okay so it does sound like there might have been some direct trauma to that area now it says here that this happened about three weeks ago were you able it sounds like you were able to get up and continue but you were having some pain did you take anything at that time to help with that shoulder pain patient: yeah i i iced the arm and then i also i also took some advil
D2N202
2
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay so it does sound like there might have been some direct trauma to that area now it says here that this happened about three weeks ago were you able it sounds like you were able to get up and continue but you were having some pain did you take anything at that time to help with that shoulder pain
5,173
doctor: okay now have you had any shoulder pain before of that right shoulder or is this the first time or or the first insult to that area patient: first time
D2N202
3
[ "Personal History" ]
[ "Subjective" ]
okay now have you had any shoulder pain before of that right shoulder or is this the first time or or the first insult to that area
5,174
doctor: okay and now are you able to move that right arm for me patient: yes i'm able to move but i do have some pain lifting overhead raising my arm overhead
D2N202
4
[ "Acute Symptoms", "Physical Examination" ]
[ "Subjective", "Objective" ]
okay and now are you able to move that right arm for me
5,175
doctor: okay alright now do you have pain all the time or does it come and go patient: it is some pain is all the time but it some is intermittent
D2N202
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright now do you have pain all the time or does it come and go
5,176
doctor: okay now i you mentioned that you had taken some ibuprofen for that pain now let's talk a little bit about your pain rating okay zero being none ten being the worst pain you've ever felt in your life can you rate your pain for me without any tylenol or advil or any nsaid can you rate your pain for me patient: about a six
D2N202
6
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay now i you mentioned that you had taken some ibuprofen for that pain now let's talk a little bit about your pain rating okay zero being none ten being the worst pain you've ever felt in your life can you rate your pain for me without any tylenol or advil or any nsaid can you rate your pain for me
5,177
doctor: okay now when you take that medication can you rate your pain for me what what's that pain level get to patient: it goes down to about a four
D2N202
7
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay now when you take that medication can you rate your pain for me what what's that pain level get to
5,178
doctor: okay so it does help take the edge off of that pain and and you're able to kinda move around a little bit then patient: yes
D2N202
8
[ "Acute Symptoms" ]
[ "Subjective" ]
okay so it does help take the edge off of that pain and and you're able to kinda move around a little bit then
5,179
doctor: okay so the remodel tell me a little bit about that my wife and i were working on our remodel and we went they just built the brand-new lowe's here in town have you guys been there yet patient: no we have not
D2N202
9
[ "Other Socials" ]
[ "Subjective" ]
okay so the remodel tell me a little bit about that my wife and i were working on our remodel and we went they just built the brand-new lowe's here in town have you guys been there yet
5,180
doctor: well i did n't know if you know this or not but you can save big money there that's the rumor patient: okay
D2N202
10
[ "Chitchat" ]
[ "Null" ]
well i did n't know if you know this or not but you can save big money there that's the rumor
5,181
doctor: so yeah we we've been down there we got some pain we we got went and got some samples and then hey while we were there we ended up deciding to put down a bunch of flooring too so i really recommend you guys if you get a chance go over there and take a look at their sales and and see if you ca n't finish your remodeled project patient: that sounds great i'll have to take a look at the flooring as well
D2N202
11
[ "Chitchat" ]
[ "Null" ]
so yeah we we've been down there we got some pain we we got went and got some samples and then hey while we were there we ended up deciding to put down a bunch of flooring too so i really recommend you guys if you get a chance go over there and take a look at their sales and and see if you ca n't finish your remodeled project
5,182
doctor: that sounds good so now just out of curiosity are you experiencing any numbness or tingling in in your arm or hand patient: i did when i initially hurt it but i'm not no longer having any numbness or tingling
D2N202
12
[ "Vegetative History" ]
[ "Subjective" ]
that sounds good so now just out of curiosity are you experiencing any numbness or tingling in in your arm or hand
5,183
doctor: okay so a little bit about my physical exam i'm gon na do a quick physical exam on you today now your vitals look good but specifically on your right shoulder exam you do have limited active and passive range of motion and there is tenderness to the greater tuberosity of the humerus now there is no tenderness at your sternoclavicular joint and you do have good strong bilateral hand grips and on your neurovascular exam of your right arm you do have brisk capillary refill of less than three seconds and you do have equal and bilateral response to sensation and touch which is good now taking a look at your x-ray that we did when you came in today good news is that right shoulder x-ray reveals no fracture or bony abnormality mkay so let me tell you a little bit about my assessment and plan now i your symptoms are most likely due to rotator cuff tendinopathy i think that you've injured the tendons of the muscles that make up the shoulder so that i think that's that's why you are having the that shoulder pain i do wan na order an mri of that right shoulder just to make sure that nothing else is going on now i'm gon na refer you to physical therapy and that's gon na be about six to eight weeks now my patients are very successful with their pt and let's see how you do before we make the decision that we would do additional treatment such as a steroid injection to that shoulder i do want you to continue to take an nsaid if you can tolerate tylenol i want you to go ahead and take tylenol for that pain do you have any questions comments or concerns about our treatment plan patient: no i think it sounds good ca n't wait to to get some relief
D2N202
13
[ "Physical Examination", "Discussion", "Medication", "Radiology Examination", "Referral", "Diagnostic Testing", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay so a little bit about my physical exam i'm gon na do a quick physical exam on you today now your vitals look good but specifically on your right shoulder exam you do have limited active and passive range of motion and there is tenderness to the greater tuberosity of the humerus now there is no tenderness at your sternoclavicular joint and you do have good strong bilateral hand grips and on your neurovascular exam of your right arm you do have brisk capillary refill of less than three seconds and you do have equal and bilateral response to sensation and touch which is good now taking a look at your x-ray that we did when you came in today good news is that right shoulder x-ray reveals no fracture or bony abnormality mkay so let me tell you a little bit about my assessment and plan now i your symptoms are most likely due to rotator cuff tendinopathy i think that you've injured the tendons of the muscles that make up the shoulder so that i think that's that's why you are having the that shoulder pain i do wan na order an mri of that right shoulder just to make sure that nothing else is going on now i'm gon na refer you to physical therapy and that's gon na be about six to eight weeks now my patients are very successful with their pt and let's see how you do before we make the decision that we would do additional treatment such as a steroid injection to that shoulder i do want you to continue to take an nsaid if you can tolerate tylenol i want you to go ahead and take tylenol for that pain do you have any questions comments or concerns about our treatment plan
5,184
doctor: okay so i know we ordered it for six to eight weeks but i wan na see you again in two weeks and we'll evaluate how you're doing and make some additional treatment plan at that at that time okay patient: okay
D2N202
14
[ "Follow-up" ]
[ "Plan" ]
okay so i know we ordered it for six to eight weeks but i wan na see you again in two weeks and we'll evaluate how you're doing and make some additional treatment plan at that at that time okay
5,185
doctor: alright sounds good we will get the nurse come in and she will take care of you and i will see you in two weeks patient: thank you
D2N202
15
[ "Follow-up" ]
[ "Plan" ]
alright sounds good we will get the nurse come in and she will take care of you and i will see you in two weeks
5,186
doctor: thank you
D2N202
16
[ "Chitchat" ]
[ "Null" ]
doctor: thank you
5,187
doctor: good afternoon matthew how are you patient: i'm okay
D2N203
0
[ "Greetings" ]
[ "Subjective" ]
good afternoon matthew how are you
5,188
doctor: it looks like here that the that you've been brought in for some vision changes and looks like you're having trouble with your right eye can you tell me a little bit about what brought you in to see me today patient: yeah you know i started noticing my wife and i we we eat out almost every night and it's when especially when we go to fancy place
D2N203
1
[ "Acute Symptoms" ]
[ "Subjective" ]
it looks like here that the that you've been brought in for some vision changes and looks like you're having trouble with your right eye can you tell me a little bit about what brought you in to see me today
5,189
doctor: mm-hmm patient: i have trouble adjusting in the that dark dim environment
D2N203
2
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm
5,190
doctor: okay and i reviewed my technician's notes before i came in to see you and it says you know you you've been having that decreased vision when you're reading especially in dark place like you just said but it also mentions here that it looks like you told her that when you look at straight lines like in your door frame it looks like things have been looking a little crooked to you how long has that been going on patient: well you know it's been going on a little while probably getting worse over the last three to four months and you know my my office has paneling and you know how that paneling has that dark grooves in it those straight lines well they always look wavy to me
D2N203
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and i reviewed my technician's notes before i came in to see you and it says you know you you've been having that decreased vision when you're reading especially in dark place like you just said but it also mentions here that it looks like you told her that when you look at straight lines like in your door frame it looks like things have been looking a little crooked to you how long has that been going on
5,191
doctor: okay alright so it's been going on a few months now you mentioned that you and your wife go out to eat every night have you tried the new the new italium place over there on main street patient: my gosh yes we were just there the other night down in the it's down in the basement of that big building yeah we went there the other night and i got ta tell you it was like the saprano family was sitting across from us there was this bunch of old guys that had bottles of of red wine all over the table and they were my gosh it was so good and the food i mean i mean i ca n't tell you how great the food was
D2N203
4
[ "Chitchat" ]
[ "Null" ]
okay alright so it's been going on a few months now you mentioned that you and your wife go out to eat every night have you tried the new the new italium place over there on main street
5,192
doctor: it was amazing my wife and i went over there the other day and when we walked downstairs it was like i was walking into a scene out of saprano's patient: mm-hmm
D2N203
6
[ "Chitchat" ]
[ "Null" ]
it was amazing my wife and i went over there the other day and when we walked downstairs it was like i was walking into a scene out of saprano's
5,193
doctor: but the food was amazing it was the best egg plant parmer's john i've i've ever had where really super excited about going back there here very very soon patient: yeah i had the bio marsal and it was my gosh it was to die for
D2N203
7
[ "Chitchat" ]
[ "Null" ]
but the food was amazing it was the best egg plant parmer's john i've i've ever had where really super excited about going back there here very very soon
5,194
doctor: i'll have to get that next time i go so in reviewing your paperwork here it looks like you made mention that you smoke are you still smoking about a pack a day patient: yeah i i tried i've tried i've done hypnosis i've done lozenges i've done chewing gum and i get real close but you know i'll just go out one evening without the wife and and the next thing i know i'm i'm you know buying a cigarette off of somebody and it's it's really hard for me to get that stopped
D2N203
8
[ "Drug History", "Drug History" ]
[ "Subjective" ]
i'll have to get that next time i go so in reviewing your paperwork here it looks like you made mention that you smoke are you still smoking about a pack a day
5,195
doctor: yeah i i appreciate that but it's really gon na be important that you try to to either cut back or quit smoking altogether now that leads me into my next concern here it looks like you have a history of high blood pressure and i'm just wondering are you are you taking your blood pressure medication as prescribed and and are you checking your blood pressures on a regular basis patient: i'm glad you just mentioned that because i have n't taken my blood pressure pill for a while it's up in the cupboard and it's back in that corner and i just i ca n't forget to take it
D2N203
9
[ "Therapeutic History", "Drug History" ]
[ "Subjective" ]
yeah i i appreciate that but it's really gon na be important that you try to to either cut back or quit smoking altogether now that leads me into my next concern here it looks like you have a history of high blood pressure and i'm just wondering are you are you taking your blood pressure medication as prescribed and and are you checking your blood pressures on a regular basis
5,196
doctor: okay it's really gon na be important that you take your medication for your blood pressure as prescribed i'd really like to see you start doing that today and then let's let's go ahead and and let's set that that pill bottle down on the counter and see if that does n't help you remember to take that blood pressure medicine if it's okay with you i would like to do a a quick physical exam on your eyes i'm gon na go ahead and take off your glasses and put your chin here in the chin rest for me patient: okay that's a bright light
D2N203
10
[ "Therapeutic History", "Physical Examination" ]
[ "Subjective", "Objective" ]
okay it's really gon na be important that you take your medication for your blood pressure as prescribed i'd really like to see you start doing that today and then let's let's go ahead and and let's set that that pill bottle down on the counter and see if that does n't help you remember to take that blood pressure medicine if it's okay with you i would like to do a a quick physical exam on your eyes i'm gon na go ahead and take off your glasses and put your chin here in the chin rest for me
5,197
doctor: yeah i'm sorry about that it it's just gon na help me check the lenses in both of your eyes so it looks like the anterior segment examination reveals posterior chamber intraocular lenses in both eyes for the right eye the cornea is clear no nvi peak hole cup to disc is . two fundus examination of the right eye shows the retina to be attached three hundred and sixty degrees no holes or tears noted and rpe changes in the fovea now the posterior segment exam shows drusen in the macula retinal thickening and presence of subretinal fluid and exudate accumulation and it is positive for a hemorrhage now for your left eye the cornea is clear no mvi pecal cup to disc is . three rpe changes in the fovea no hemorrhage noted or subretinal fluid noted and the retina is attached appropriately now i reviewed the results of your diagnostic exam so the otc exam shows those drusen deposits under the rpe which is the retinal pigment epithelium and then the subretinal fluid so the srf accumulation and choroidal neovascular membrane can also be visualized in that test now the fluorescein angiography so the using the the fluorescein there reveals that the focal area of the leakage in the right eye is consistent with neurovascular age related macular degeneration now for my impression and plan it looks like the diagnostic test and the eye exams are consistent with the neovascular age related macular degeneration also called wet macular degeneration now it's advanced to a stage that usually leads to more severe vision loss happening now this happens when those abnormal blood vessels start to grow beneath the retina what happens is they leak fluid and blood which is wides called wet macular degeneration and what happens is secondary to that it creates a large blind spot in the center of your visual field that's why it it kinda looks like you'll see a black dot in the center of your vision field now it is the most common cause of severe vision loss now the good news is we have a plan for you for this now once a month i want to give you an injection of lucent now it's gon na be injected in the vitreous portion of the eye after we numb the eye so you're not gon na feel any pain and those injections yeah i know the one once i numb the eye you wo n't feel any pain in that injection at all patients report no pain at all for the actual injection patient: have you ever somebody stick a needle in your eye
D2N203
11
[ "Physical Examination", "Acute Assessment", "Medication" ]
[ "Objective", "Assessment", "Plan" ]
yeah i'm sorry about that it it's just gon na help me check the lenses in both of your eyes so it looks like the anterior segment examination reveals posterior chamber intraocular lenses in both eyes for the right eye the cornea is clear no nvi peak hole cup to disc is . two fundus examination of the right eye shows the retina to be attached three hundred and sixty degrees no holes or tears noted and rpe changes in the fovea now the posterior segment exam shows drusen in the macula retinal thickening and presence of subretinal fluid and exudate accumulation and it is positive for a hemorrhage now for your left eye the cornea is clear no mvi pecal cup to disc is . three rpe changes in the fovea no hemorrhage noted or subretinal fluid noted and the retina is attached appropriately now i reviewed the results of your diagnostic exam so the otc exam shows those drusen deposits under the rpe which is the retinal pigment epithelium and then the subretinal fluid so the srf accumulation and choroidal neovascular membrane can also be visualized in that test now the fluorescein angiography so the using the the fluorescein there reveals that the focal area of the leakage in the right eye is consistent with neurovascular age related macular degeneration now for my impression and plan it looks like the diagnostic test and the eye exams are consistent with the neovascular age related macular degeneration also called wet macular degeneration now it's advanced to a stage that usually leads to more severe vision loss happening now this happens when those abnormal blood vessels start to grow beneath the retina what happens is they leak fluid and blood which is wides called wet macular degeneration and what happens is secondary to that it creates a large blind spot in the center of your visual field that's why it it kinda looks like you'll see a black dot in the center of your vision field now it is the most common cause of severe vision loss now the good news is we have a plan for you for this now once a month i want to give you an injection of lucent now it's gon na be injected in the vitreous portion of the eye after we numb the eye so you're not gon na feel any pain and those injections yeah i know the one once i numb the eye you wo n't feel any pain in that injection at all patients report no pain at all for the actual injection
5,198
doctor: yeah literally yeah patient: yeah
D2N203
13
[ "Chitchat" ]
[ "Null" ]
yeah literally yeah
5,199