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aci_bench_intent_annotated

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doctor: all right , well , i'm gon na scoot up closer and just take a quick look at your hand . all right , so , lean over here . all right , so on this exam today , we have a very pleasant , cooperative , healthy male , no distress . his heart rate is regular rate , rhythm , 2+ radial pulse , no swelling or bruise , bruising in the palm over the volar surface of his index finger , normal creases , slightly diminished over the pip of the index finger compared to the middle finger . his index finger rests in a 10-degree pip-flexed , uh , position . all right , is that uncomfortable to correct that , and is it uncomfortable now here ? patient: yeah , uh , when you push on it , yeah .
D2N022
10
[ "Physical Examination" ]
[ "Objective" ]
all right , well , i'm gon na scoot up closer and just take a quick look at your hand . all right , so , lean over here . all right , so on this exam today , we have a very pleasant , cooperative , healthy male , no distress . his heart rate is regular rate , rhythm , 2+ radial pulse , no swelling or bruise , bruising in the palm over the volar surface of his index finger , normal creases , slightly diminished over the pip of the index finger compared to the middle finger . his index finger rests in a 10-degree pip-flexed , uh , position . all right , is that uncomfortable to correct that , and is it uncomfortable now here ?
600
doctor: all right , how about here ? patient: um , there , it's not .
D2N022
11
[ "Physical Examination" ]
[ "Objective" ]
all right , how about here ?
601
doctor: okay , not as bad ? patient: yeah , it feels , uh , a little numb .
D2N022
12
[ "Physical Examination" ]
[ "Objective" ]
okay , not as bad ?
602
doctor: gotcha , all right . bend , bend the tip of this finger . bend it as hard as you can . keep bending . keep bending . all right , straighten it out . all right , and now , bend it for me as best you can . patient: my goodness . it feels like it's , it's tearing in there .
D2N022
13
[ "Physical Examination" ]
[ "Objective" ]
gotcha , all right . bend , bend the tip of this finger . bend it as hard as you can . keep bending . keep bending . all right , straighten it out . all right , and now , bend it for me as best you can .
603
doctor: okay , okay . well , bend the tip of this finger , and bend it as hard as you can . keep bending . all right , straighten that out , and now , bend it for me as best you can . all right , good . now , bend that finger , and i'm going to pull , put it down like this . and then bend that finger for me . okay , sorry , can you bend it for me ? all right . now , make a fist . great , so relax the finger . all right , so just keep it , keep , when i bend the finger , we're just going to bend that finger where it meets the hand . is that okay there ? patient: ow , .
D2N022
14
[ "Physical Examination" ]
[ "Objective" ]
okay , okay . well , bend the tip of this finger , and bend it as hard as you can . keep bending . all right , straighten that out , and now , bend it for me as best you can . all right , good . now , bend that finger , and i'm going to pull , put it down like this . and then bend that finger for me . okay , sorry , can you bend it for me ? all right . now , make a fist . great , so relax the finger . all right , so just keep it , keep , when i bend the finger , we're just going to bend that finger where it meets the hand . is that okay there ?
604
doctor: okay , okay . so all the hurt , it seems , is stretching , because you have n't been doing this for so long . so , you know what i mean ? so , um , you're going to have to start really doing that . patient: well , i've tried . i even bought myself a splint .
D2N022
15
[ "Discussion", "Acute Assessment", "Other Treatments" ]
[ "Assessment", "Plan" ]
okay , okay . so all the hurt , it seems , is stretching , because you have n't been doing this for so long . so , you know what i mean ? so , um , you're going to have to start really doing that .
605
doctor: well , but a splint does n't help move you . it actually immobilizes you . patient: okay . i thought it would straighten it out .
D2N022
16
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
well , but a splint does n't help move you . it actually immobilizes you .
606
doctor: no , no . so , so you really need to start bending the finger right here for me , as hard as you can , and keep going , going . all right , so , so you're okay . all right , so i would say the following , that there is a partial tear in one of the two flexor tendons . there is the fdp and the fds , and the fds is the least important of the two . so the mri shows that it's the fds , the flexor digitorum superficialis , which is the least important of the two . patient: okay .
D2N022
17
[ "Physical Examination", "Acute Assessment", "Radiology Examination" ]
[ "Objective", "Assessment" ]
no , no . so , so you really need to start bending the finger right here for me , as hard as you can , and keep going , going . all right , so , so you're okay . all right , so i would say the following , that there is a partial tear in one of the two flexor tendons . there is the fdp and the fds , and the fds is the least important of the two . so the mri shows that it's the fds , the flexor digitorum superficialis , which is the least important of the two .
607
doctor: uh , now , there's two halves of it . so it's a partial tear of one half of a whole tendon . that's not that important , and the other one is just fine . patient: so the good one is good ?
D2N022
18
[ "Radiology Examination" ]
[ "Objective" ]
uh , now , there's two halves of it . so it's a partial tear of one half of a whole tendon . that's not that important , and the other one is just fine .
608
doctor: yes , correct . so the one that goes all the way to the tip is good . patient: okay , good .
D2N022
19
[ "Radiology Examination" ]
[ "Objective" ]
yes , correct . so the one that goes all the way to the tip is good .
609
doctor: yeah , so you know , i think what you have got so much scar tissue and inflammation around the fds tendon blocking excursion of these other tendons , that they ca n't get through to the pulley . patient: okay , all right .
D2N022
20
[ "Acute Assessment" ]
[ "Assessment" ]
yeah , so you know , i think what you have got so much scar tissue and inflammation around the fds tendon blocking excursion of these other tendons , that they ca n't get through to the pulley .
610
doctor: so what i would recommend what we try is a cortisone injection , and i would avoid the dexamethasone , because i saw you have a little reaction to that . but we could use the betamethasone , which is a celestone . patient: i've gotten another , uh , methylprednisolone , and that itched me like crazy .
D2N022
21
[ "Medication" ]
[ "Plan" ]
so what i would recommend what we try is a cortisone injection , and i would avoid the dexamethasone , because i saw you have a little reaction to that . but we could use the betamethasone , which is a celestone .
611
doctor: did it ? yeah , this one is water-soluble , and i think it's fairly low toxicity , but high benefit , and i think decreasing the pain will encourage you to move that finger . patient: all right , we'll give it a try .
D2N022
22
[ "Discussion", "Medication" ]
[ "Plan" ]
did it ? yeah , this one is water-soluble , and i think it's fairly low toxicity , but high benefit , and i think decreasing the pain will encourage you to move that finger .
612
doctor: good . so , you do the shot , and it's going to take about three to five days before it starts feeling better . and then probably over the next couple of weeks , it'll start feeling even better . patient: perfect .
D2N022
23
[ "Discussion", "Medication" ]
[ "Plan" ]
good . so , you do the shot , and it's going to take about three to five days before it starts feeling better . and then probably over the next couple of weeks , it'll start feeling even better .
613
doctor: all right , so take advantage of that . you've got ta start moving the finger . you're not going to tear anything or break a bone , uh , because your intensors , extensors are intact . but your collateral ligaments are intact , so you've got a stiff , sore finger . i'm going to try to help as much as i can with this soreness part , and then you have to do all the stiff part . patient: the lady in occupational therapy tried some maneuvers to straighten the finger out , but it even hurt after i left . the whole thing just swelled up .
D2N022
24
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
all right , so take advantage of that . you've got ta start moving the finger . you're not going to tear anything or break a bone , uh , because your intensors , extensors are intact . but your collateral ligaments are intact , so you've got a stiff , sore finger . i'm going to try to help as much as i can with this soreness part , and then you have to do all the stiff part .
614
doctor: hmm . okay , so it was injured , and you had scar tissue . and then , you had post-traumatic inflammation . and so , this will help some with all of that . it's not going to make it to where your finger is like , , my finger does n't hurt at all , but it will make it to where at least tolerable , to where you can make some gains . and we actually might need to repeat this as well . patient: will i be able to drive ? i drove myself here today , so ...
D2N022
25
[ "Discussion", "Medication" ]
[ "Plan" ]
hmm . okay , so it was injured , and you had scar tissue . and then , you had post-traumatic inflammation . and so , this will help some with all of that . it's not going to make it to where your finger is like , , my finger does n't hurt at all , but it will make it to where at least tolerable , to where you can make some gains . and we actually might need to repeat this as well .
615
doctor: yeah , it may feel a little weird , but it's totally safe for you to drive . patient: okay , good .
D2N022
26
[ "Discussion" ]
[ "Plan" ]
yeah , it may feel a little weird , but it's totally safe for you to drive .
616
doctor: so for mr . gutierrez , just put that he has a post-traumatic rather severe stenosing tenosynovitis of his right index finger , and the plan is steroid injection today , do a trigger injection , but i'm using a cc of betamethasone . so , mr . gutierrez , do you have , um , therapy scheduled or set up ? patient: uh , not at the moment .
D2N022
27
[ "Discussion", "Acute Assessment", "Referral", "Medication" ]
[ "Assessment", "Plan" ]
so for mr . gutierrez , just put that he has a post-traumatic rather severe stenosing tenosynovitis of his right index finger , and the plan is steroid injection today , do a trigger injection , but i'm using a cc of betamethasone . so , mr . gutierrez , do you have , um , therapy scheduled or set up ?
617
doctor: all right , well , i mean , you know that you need to move that finger , and i think to the degree that they can help you do that . so i want you to move that finger , finger , but i think it would be , uh , beneficial for you to have an accountability , um , so at least you know to check in with them once a week with somebody . patient: um , okay . that's kinda why i'm here , for you to tell me what needs to be done , you know ?
D2N022
28
[ "Discussion", "Referral" ]
[ "Plan" ]
all right , well , i mean , you know that you need to move that finger , and i think to the degree that they can help you do that . so i want you to move that finger , finger , but i think it would be , uh , beneficial for you to have an accountability , um , so at least you know to check in with them once a week with somebody .
618
doctor: yeah , so i'll write you out , um , an outpatient prescription . i think if you go back to the same people where you were before , i'm hoping that after this injection , you're going to be able to do a whole lot more with them . so let's do outpatient once a week for six weeks , um , and then full active and passive range of motion is the goal with no restrictions . patient: all right , sounds like a plan .
D2N022
29
[ "Referral" ]
[ "Plan" ]
yeah , so i'll write you out , um , an outpatient prescription . i think if you go back to the same people where you were before , i'm hoping that after this injection , you're going to be able to do a whole lot more with them . so let's do outpatient once a week for six weeks , um , and then full active and passive range of motion is the goal with no restrictions .
619
doctor: all right , well , i will have the nurse set up the injection procedure , and we'll , and i'll be back shortly . patient: thanks , doc .
D2N022
30
[ "Chitchat" ]
[ "Null" ]
all right , well , i will have the nurse set up the injection procedure , and we'll , and i'll be back shortly .
620
doctor: right trigger finger injection template . attempted to inject one cc of celestone with f- , a half a cc of lidocaine . however , the patient had a dramatic and violent painful reaction to the introduction of the needle , with contortions of the hand , and with dangerously withdrawing the hand with concerns for secondary needle stick . needle was withdrawn . the patient was counseled as to the importance of attempting to get some therapeutic steroid in the flexor tendon sheath . we attempted a second time for a similar injection using the same technique with one cc of celestone and half a cc of lidocaine . a small parma- , uh , palmar vein bled a scant amount , which was cleaned up and band-aid applied . reassured on multiple occasions that no harm was done to his finger . recommended icing in it this evening , and taking ibuprofen .
D2N022
31
[ "Medication", "Discussion" ]
[ "Plan" ]
doctor: right trigger finger injection template . attempted to inject one cc of celestone with f- , a half a cc of lidocaine . however , the patient had a dramatic and violent painful reaction to the introduction of the needle , with contortions of the hand , and with dangerously withdrawing the hand with concerns for secondary needle stick . needle was withdrawn . the patient was counseled as to the importance of attempting to get some therapeutic steroid in the flexor tendon sheath . we attempted a second time for a similar injection using the same technique with one cc of celestone and half a cc of lidocaine . a small parma- , uh , palmar vein bled a scant amount , which was cleaned up and band-aid applied . reassured on multiple occasions that no harm was done to his finger . recommended icing in it this evening , and taking ibuprofen .
621
doctor: next patient is paul edwards , date of birth is january 15th 1962 . so he's a 59 year old hiv positive gentleman here for hypogonadism . patient was last seen on november 24th 2020 . his notable things are number one , he is on 1 milliliter every 10 days , uh , his levels were less than 300 to begin with . he's on finasteride currently . he also takes cialis daily so he takes all his pills just from me . um , patient's other area of concern is gynecomastia which is ... which we will discuss with him today . his last psa was 0.66 and his last testosterone was greater than 1,500 . hey , how are you today ? patient: all right , how have you been ?
D2N023
0
[ "Acute Symptoms", "Personal History", "Therapeutic History", "Lab Examination" ]
[ "Subjective", "Objective" ]
next patient is paul edwards , date of birth is january 15th 1962 . so he's a 59 year old hiv positive gentleman here for hypogonadism . patient was last seen on november 24th 2020 . his notable things are number one , he is on 1 milliliter every 10 days , uh , his levels were less than 300 to begin with . he's on finasteride currently . he also takes cialis daily so he takes all his pills just from me . um , patient's other area of concern is gynecomastia which is ... which we will discuss with him today . his last psa was 0.66 and his last testosterone was greater than 1,500 . hey , how are you today ?
622
doctor: i'm good . patient: good , good .
D2N023
1
[ "Chitchat" ]
[ "Null" ]
i'm good .
623
doctor: have you lost some weight or are you at least putting on some muscle ? you look trim . patient: no , i think i'm pretty much the same as i've always been .
D2N023
2
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
have you lost some weight or are you at least putting on some muscle ? you look trim .
624
doctor: really ? okay , maybe it's just your black shirt . makes you look thin . patient: yeah , i guess that's it .
D2N023
3
[ "Chitchat" ]
[ "Null" ]
really ? okay , maybe it's just your black shirt . makes you look thin .
625
doctor: so health wise , how is everything going ? patient: good , the testosterone's going well .
D2N023
4
[ "Personal History" ]
[ "Subjective" ]
so health wise , how is everything going ?
626
doctor: that's great . patient: uh , it helped me out . i feel good , more vigorous , sleeping well and i think it's having some positive effects . not so much physically because like i said i've- i've been this way my whole life , but i'm seeing some good improvements in my bloodwork .
D2N023
5
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
that's great .
627
doctor: okay , well that's good . patient: so the finasteride i'm only taking half a pill , it's the 5 milligram one .
D2N023
6
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay , well that's good .
628
doctor: yeah , i remember you telling me that . patient: and cialis , on the days i work out i take 5 milligrams otherwise i take two and a half milligram pills , but , uh , i have been out of it .
D2N023
7
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
yeah , i remember you telling me that .
629
doctor: good . it's always great to hear . well let's take a look . uhm , i'm gon na listen to your heart and lungs . patient: okay .
D2N023
9
[ "Physical Examination" ]
[ "Objective" ]
good . it's always great to hear . well let's take a look . uhm , i'm gon na listen to your heart and lungs .
630
doctor: please use my general exam template , all right . just take a few breaths . patient: okay .
D2N023
10
[ "Chitchat" ]
[ "Null" ]
please use my general exam template , all right . just take a few breaths .
631
doctor: in and out . patient: okay .
D2N023
11
[ "Chitchat" ]
[ "Null" ]
in and out .
632
doctor: all right , everything sounds good , no concerns there . patient: great . so i wanted to show you something .
D2N023
12
[ "Physical Examination" ]
[ "Objective" ]
all right , everything sounds good , no concerns there .
633
doctor: okay , this is your cholesterol ? patient: yeah , my cholesterol and triglycerides . uh , i used to have high triglycerides , you see they were 265 milligrams per deciliter , and i took my first dose of the testosterone on the 28th .
D2N023
14
[ "Lab Examination" ]
[ "Objective" ]
okay , this is your cholesterol ?
634
doctor: right . patient: now 5 months later look at my numbers .
D2N023
15
[ "Lab Examination" ]
[ "Objective" ]
right .
635
doctor: wow , that's remarkable . patient: is it the test ? it's the only change .
D2N023
16
[ "Lab Examination" ]
[ "Objective" ]
wow , that's remarkable .
636
doctor: i do n't know , i have n't honestly seen many guys over the years that have cholesterol problems and this . i mean there's a big correlation between diabetic control and testosterone replacement , meaning those who get good levels of their test see their diabetic control improve . patient: yeah .
D2N023
17
[ "Discussion", "Lab Examination" ]
[ "Objective", "Plan" ]
i do n't know , i have n't honestly seen many guys over the years that have cholesterol problems and this . i mean there's a big correlation between diabetic control and testosterone replacement , meaning those who get good levels of their test see their diabetic control improve .
637
doctor: but i have n't seen a lot of data on the impact on cholesterol . regardless , we will take it . patient: i agree . i was very impressed with my triglycerides and was just wondering if the test may be what's helping .
D2N023
18
[ "Lab Examination" ]
[ "Objective" ]
but i have n't seen a lot of data on the impact on cholesterol . regardless , we will take it .
638
doctor: yeah , that's an unbelievable difference . patient: 145 milligrams per deciliter from 265 milligrams per deciliter is awesome . i also read that it- it's cardioprotective .
D2N023
19
[ "Lab Examination" ]
[ "Objective" ]
yeah , that's an unbelievable difference .
639
doctor: absolutely . patient: my red blood cell count has increased .
D2N023
20
[ "Lab Examination" ]
[ "Objective" ]
absolutely .
640
doctor: yeah , i saw that . it's fine though . patient: stable .
D2N023
21
[ "Lab Examination" ]
[ "Objective" ]
yeah , i saw that . it's fine though .
641
doctor: your psa today is also , uh , is good also . it's , uh , .6 i think . patient: yeah . , is it ?
D2N023
22
[ "Lab Examination" ]
[ "Objective" ]
your psa today is also , uh , is good also . it's , uh , .6 i think .
642
doctor: yeah , it was .5 last year and anything under 4 is good . patient: nice , that's good news .
D2N023
23
[ "Lab Examination" ]
[ "Objective" ]
yeah , it was .5 last year and anything under 4 is good .
643
doctor: so it just needs to be checked every year or so . patient: so in terms of , uh , estrogen control i've been hearing that indole-3-carbinol , or broccoli extract , supposedly can improve my estrogen levels . have you ever heard of it ?
D2N023
24
[ "Lab Examination" ]
[ "Objective" ]
so it just needs to be checked every year or so .
644
doctor: yeah , i've heard of it but i have n't had anybody consistently use it . i mean , your levels are fine and we checked your estra- estradiol and it was not elevated , so . patient: okay .
D2N023
25
[ "Discussion" ]
[ "Plan" ]
yeah , i've heard of it but i have n't had anybody consistently use it . i mean , your levels are fine and we checked your estra- estradiol and it was not elevated , so .
645
doctor: i would argue that we could test that in the fall if you want , but we do n't need to do , uh , do any more tests ... any more than test once a year , excuse me . patient: okay , what about increasing my testosterone to 175 milligrams ? i'm at 140 now .
D2N023
26
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
i would argue that we could test that in the fall if you want , but we do n't need to do , uh , do any more tests ... any more than test once a year , excuse me .
646
doctor: well , your levels are high . patient: are they right now ?
D2N023
27
[ "Lab Examination" ]
[ "Objective" ]
well , your levels are high .
647
doctor: well , i mean they were last time . patient: yeah but i just- just injected though , or i had right before that was taken .
D2N023
28
[ "Lab Examination" ]
[ "Objective", "Plan" ]
well , i mean they were last time .
648
doctor: i know . i know you had then , uh , when did you inject this time ? patient: i figure i'm on my eighth day today .
D2N023
29
[ "Therapeutic History" ]
[ "Subjective" ]
i know . i know you had then , uh , when did you inject this time ?
649
doctor: all right . patient: i have a little med calendar and i put checks and ts on it . that helps me .
D2N023
31
[ "Chitchat" ]
[ "Null" ]
all right .
650
doctor: that's a great idea . so look , the biggest issue i've seen , even if your levels today are around 700 , is that your peaks are getting greater than 1,500 , putting you at a higher chance of needing to come off due to blood thickness . and your risk will only astronomically go up the higher the dose that we go on . patient: okay .
D2N023
32
[ "Discussion" ]
[ "Plan" ]
that's a great idea . so look , the biggest issue i've seen , even if your levels today are around 700 , is that your peaks are getting greater than 1,500 , putting you at a higher chance of needing to come off due to blood thickness . and your risk will only astronomically go up the higher the dose that we go on .
651
doctor: you look well , your levels are good and you're feeling well . patient: yeah , i'm feeling good .
D2N023
33
[ "Reassessment" ]
[ "Assessment" ]
you look well , your levels are good and you're feeling well .
652
doctor: i'm going to be blunt . unfortunately this happens often where you're feeling good but you want to feel really good . i mean , i get it and this is why people get into problems with this stuff , right ? it's like , back in the day when it was n't prescribed by doctors and people would get it at gyms and stuff and they would take huge doses . and then they would have a heart attack at 50 . patient: yeah , they have to be taking a lot .
D2N023
34
[ "Discussion", "Medication" ]
[ "Plan" ]
i'm going to be blunt . unfortunately this happens often where you're feeling good but you want to feel really good . i mean , i get it and this is why people get into problems with this stuff , right ? it's like , back in the day when it was n't prescribed by doctors and people would get it at gyms and stuff and they would take huge doses . and then they would have a heart attack at 50 .
653
doctor: likely they are taking more than testosterone , but still . patient: and they are taking stuff for a long time .
D2N023
35
[ "Discussion", "Medication" ]
[ "Plan" ]
likely they are taking more than testosterone , but still .
654
doctor: true . but right now i would not change your dose . patient: okay .
D2N023
36
[ "Medication" ]
[ "Plan" ]
true . but right now i would not change your dose .
655
doctor: make sense ? patient: it does , i appreciate the discussion .
D2N023
37
[ "Chitchat" ]
[ "Null" ]
make sense ?
656
doctor: no problem . what pharmacy are you using ? have you changed it or anything ? patient: no changes , i use walmart pharmacy . i do need more cialis and finasteride .
D2N023
38
[ "Therapeutic History", "Other Socials" ]
[ "Subjective" ]
no problem . what pharmacy are you using ? have you changed it or anything ?
657
doctor: for all of them ? patient: sure .
D2N023
40
[ "Chitchat" ]
[ "Null" ]
for all of them ?
658
doctor: all right , will do . i'm gon na get your prescriptions . patient: okay , thank you .
D2N023
41
[ "Chitchat" ]
[ "Null" ]
all right , will do . i'm gon na get your prescriptions .
659
doctor: patient is pamela cook . medical record number is 123546 . she's a 36-year-old female post bilateral reduction mammoplasty on 10-10 20-20 . hey , how are you ? patient: good . how are you ?
D2N024
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
patient is pamela cook . medical record number is 123546 . she's a 36-year-old female post bilateral reduction mammoplasty on 10-10 20-20 . hey , how are you ?
660
doctor: i'm doing well . it's good to see you . how have you been ? patient: i've been doing good .
D2N024
1
[ "Personal History" ]
[ "Subjective" ]
i'm doing well . it's good to see you . how have you been ?
661
doctor: great . how about your breasts , are they doing all right ? patient: great .
D2N024
2
[ "Personal History" ]
[ "Subjective" ]
great . how about your breasts , are they doing all right ?
662
doctor: are you having any chills , fever , nausea , or vomiting ? patient: no .
D2N024
3
[ "Vegetative History" ]
[ "Subjective" ]
are you having any chills , fever , nausea , or vomiting ?
663
doctor: good . all right . let's take a peek real quick . patient: sure .
D2N024
4
[ "Chitchat" ]
[ "Null" ]
good . all right . let's take a peek real quick .
664
doctor: how's life otherwise ? pretty good ? nothing new ? patient: no , just enjoying summertime .
D2N024
5
[ "Other Socials" ]
[ "Subjective" ]
how's life otherwise ? pretty good ? nothing new ?
665
doctor: okay . how's your family ? patient: they're good .
D2N024
6
[ "Chitchat" ]
[ "Null" ]
okay . how's your family ?
666
doctor: good . all right . i'm going to take a look at your breast now . if you would just open up your gown for me . everything looks good . patient: yeah .
D2N024
7
[ "Physical Examination" ]
[ "Objective" ]
good . all right . i'm going to take a look at your breast now . if you would just open up your gown for me . everything looks good .
667
doctor: how's your back pain ? patient: i'm not really having any more .
D2N024
8
[ "Acute Symptoms" ]
[ "Subjective" ]
how's your back pain ?
668
doctor: any hard spots , lumps , or bumps that you've noticed ? patient: i did when i came in last time when i saw your pa , ruth sanchez in march . she said i , she said she found a lump right here under my left breast , but i have n't felt it since then . but i did the massages .
D2N024
9
[ "Personal History" ]
[ "Subjective" ]
any hard spots , lumps , or bumps that you've noticed ?
669
doctor: okay , well . that that's good . uh , it's probably just the scar tissue , but everything looks good and you're healing wonderful , so . patient: i told her that the scars here was kind of bothering me and i got scar gel . i was using it everyday , but i do n't think i need it now .
D2N024
10
[ "Physical Examination" ]
[ "Objective" ]
okay , well . that that's good . uh , it's probably just the scar tissue , but everything looks good and you're healing wonderful , so .
670
doctor: yeah , that scar did widen a little bit . let me take a closer look , hang on . this one widened a little too , ? the incisions are well healed though with no signs of infection or any redness on either breast , so i'm not concerned . patient: yeah , but this one just bothered me a little bit more .
D2N024
11
[ "Physical Examination" ]
[ "Objective" ]
yeah , that scar did widen a little bit . let me take a closer look , hang on . this one widened a little too , ? the incisions are well healed though with no signs of infection or any redness on either breast , so i'm not concerned .
671
doctor: i understand . um , you can close your gown now . the only thing that is really going to help out that is to uh , to cut it out and re-close it . patient: okay
D2N024
12
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
i understand . um , you can close your gown now . the only thing that is really going to help out that is to uh , to cut it out and re-close it .
672
doctor: and you do n't want that , ? patient: i mean , not right now .
D2N024
13
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
and you do n't want that , ?
673
doctor: um , you want to come back and revisit um , maybe six months ? patient: yeah , i will do that . i still have n't , i still have some more of the gel and i can try using that again .
D2N024
14
[ "Discussion", "Follow-up" ]
[ "Plan" ]
um , you want to come back and revisit um , maybe six months ?
674
doctor: okay . keep doing that twice a day . the gel is going to lighten the color a little bit , which is already pretty light . um , but , just in that area , and it's high tension , so it's going to rub a little bit . patient: yeah , but it kind of bothers me a little bit .
D2N024
15
[ "Discussion", "Medication" ]
[ "Plan" ]
okay . keep doing that twice a day . the gel is going to lighten the color a little bit , which is already pretty light . um , but , just in that area , and it's high tension , so it's going to rub a little bit .
675
doctor: uh , i do see that . like i said , the only way to really fix that is to cut it out . patient: uh- .
D2N024
16
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
uh , i do see that . like i said , the only way to really fix that is to cut it out .
676
doctor: um , let's take a look in six months and then we'll go from there . sound like a plan ? patient: but we have n't hit a full year yet .
D2N024
17
[ "Follow-up" ]
[ "Plan" ]
um , let's take a look in six months and then we'll go from there . sound like a plan ?
677
doctor: i know . um , i would n't do any revisions anyway for scar tissue until we're at least a year out anyway . patient: okay .
D2N024
18
[ "Discussion", "Follow-up" ]
[ "Plan" ]
i know . um , i would n't do any revisions anyway for scar tissue until we're at least a year out anyway .
678
doctor: so let's wait those six months . you can keep using uh , the mederma scar gel twice a day . massage and scar gel will help for the scars . um , you can put it on other scars too , if you need . patient: okay .
D2N024
19
[ "Discussion", "Follow-up", "Medication" ]
[ "Plan" ]
so let's wait those six months . you can keep using uh , the mederma scar gel twice a day . massage and scar gel will help for the scars . um , you can put it on other scars too , if you need .
679
doctor: um , so that's what i would do . let's just get some pictures today so we can keep up um , with them . and keep an eye on these scars and then we'll go from there . patient: sounds good .
D2N024
20
[ "Diagnostic Testing" ]
[ "Plan" ]
um , so that's what i would do . let's just get some pictures today so we can keep up um , with them . and keep an eye on these scars and then we'll go from there .
680
doctor: all right , well it's good to see you . i'm glad you're doing well . patient: yeah , same here .
D2N024
21
[ "Chitchat" ]
[ "Null" ]
all right , well it's good to see you . i'm glad you're doing well .
681
doctor: all right . well , i'm going to tell the front desk six months and we'll revisit those scars . patient: all right .
D2N024
22
[ "Follow-up" ]
[ "Plan" ]
all right . well , i'm going to tell the front desk six months and we'll revisit those scars .
682
doctor: thank you . they're gon na come get your photos now , okay ? patient: okay .
D2N024
23
[ "Chitchat" ]
[ "Null" ]
thank you . they're gon na come get your photos now , okay ?
683
doctor: next patient is nicole miller . date of birth is 09/18/1949 . patient was called for a follow-up with me for chronic congestive heart failure with diastolic dysfunction . bmp's been , uh , 3,000 in march , and is about six- was up to 6,000 in april . she was increasingly dyspneic . we changed her furosemide and torsemide 20 milligrams by mouth daily . uh to note , the patient is not currently on potassium supplement . her lisinopril had- has also been increased up to 10 milligrams daily in march . also did when i saw her last april . she reported being interested in having her right knee replaced this summer at east metro . it was recommended that we work to control her cardiovascular status before surgery . hey , miss miller , how are you today ? patient: i'm doing okay , thank you .
D2N025
0
[ "Therapeutic History", "Personal History", "Greetings" ]
[ "Subjective" ]
next patient is nicole miller . date of birth is 09/18/1949 . patient was called for a follow-up with me for chronic congestive heart failure with diastolic dysfunction . bmp's been , uh , 3,000 in march , and is about six- was up to 6,000 in april . she was increasingly dyspneic . we changed her furosemide and torsemide 20 milligrams by mouth daily . uh to note , the patient is not currently on potassium supplement . her lisinopril had- has also been increased up to 10 milligrams daily in march . also did when i saw her last april . she reported being interested in having her right knee replaced this summer at east metro . it was recommended that we work to control her cardiovascular status before surgery . hey , miss miller , how are you today ?
684
doctor: i asked you to come in today because we want to keep- we want you to have this knee surgery this summer but we want to keep a close eye on you to make sure a week before your surgery you do n't suddenly go into congestive heart failure and it gets postponed . patient: yeah , that would not be good .
D2N025
1
[ "Personal History" ]
[ "Subjective" ]
i asked you to come in today because we want to keep- we want you to have this knee surgery this summer but we want to keep a close eye on you to make sure a week before your surgery you do n't suddenly go into congestive heart failure and it gets postponed .
685
doctor: i see you're scheduled on the 24th for surgery . patient: yeah , that's right .
D2N025
2
[ "Personal History" ]
[ "Subjective" ]
i see you're scheduled on the 24th for surgery .
686
doctor: okay , good . well it looks like you have lost about 3 , 3 and a half pounds since i saw you last in april . some of that might be water weight , but still , this is positive . patient: yeah , i noticed that too . i think the oxyglutinine is helping as well . my urgency to use the bathroom is much better .
D2N025
3
[ "Personal History" ]
[ "Subjective" ]
okay , good . well it looks like you have lost about 3 , 3 and a half pounds since i saw you last in april . some of that might be water weight , but still , this is positive .
687
doctor: well that's great . patient: yeah , i , i'm pleased about it too .
D2N025
4
[ "Chitchat" ]
[ "Null" ]
well that's great .
688
doctor: you ever get leg or finger cramps or anything like that ? patient: yeah , i had leg cramps the other day , but i thought it might , was maybe just because i was cold as i had my ceiling fan on and fell asleep . i had cramps when i woke up in both legs right here . um i drank pickle juice and it went right away .
D2N025
5
[ "Personal History" ]
[ "Subjective" ]
you ever get leg or finger cramps or anything like that ?
689
doctor: well do n't , do n't get crazy with the pickle juice because all of the salt in it . patient: haha , i know , i only drink about 4 ounces or so .
D2N025
6
[ "Chitchat" ]
[ "Null" ]
well do n't , do n't get crazy with the pickle juice because all of the salt in it .
690
doctor: okay good . patient: um it went away so i did n't drink anymore . i find it works a lot better than trying to put some cream on my leg .
D2N025
7
[ "Chitchat" ]
[ "Null" ]
okay good .
691
doctor: sure just , just keep it in moderation . patient: okay .
D2N025
8
[ "Chitchat" ]
[ "Null" ]
sure just , just keep it in moderation .
692
doctor: and then are you still on an iron supplement ? and are you using the bathroom okay ? patient: uh yes , everything is good .
D2N025
9
[ "Therapeutic History", "Vegetative History" ]
[ "Subjective" ]
and then are you still on an iron supplement ? and are you using the bathroom okay ?
693
doctor: good . how is your heart burn doing ? any problems with that ? patient: no , it did get bad for a while so i tried to take some prilosec and then stopped that other one .
D2N025
10
[ "Personal History" ]
[ "Subjective" ]
good . how is your heart burn doing ? any problems with that ?
694
doctor: great . patient: um and after i stopped taking that um i went back to the stomach one , so i'm doing good now .
D2N025
12
[ "Personal History" ]
[ "Subjective" ]
great .
695
doctor: okay and you're still due for a colonoscopy , correct ? patient: uh yeah , that's right .
D2N025
13
[ "Personal History" ]
[ "Subjective" ]
okay and you're still due for a colonoscopy , correct ?
696
doctor: all right , let's review your blood work real quick . i checked your hemoglobin level because you have had some anemia in the past but that is still doing great . patient: good , that's a relief to hear .
D2N025
14
[ "Lab Examination" ]
[ "Objective" ]
all right , let's review your blood work real quick . i checked your hemoglobin level because you have had some anemia in the past but that is still doing great .
697
doctor: your potassium is 3.9 so it's holding steady on the torsemide . your creatinine was .7 not .8 so you're doing well with kidney numbers . your bun may be a tiny bit elevated at 23 which is the number we look for for dehydration sometimes the kidneys , but it's not terrible . um so when i look at your numbers as a whole i think you're tolerating the torsemide okay at the current dose . i also sent out to look at the heart failure number- i sent to look at your heart failure number . there is a test called a bmp that i was monitoring and in march it was up to 3,000 and then went up to 6,000 in april before i made the change . i'm still waiting for those results . patient: okay .
D2N025
15
[ "Lab Examination" ]
[ "Objective" ]
your potassium is 3.9 so it's holding steady on the torsemide . your creatinine was .7 not .8 so you're doing well with kidney numbers . your bun may be a tiny bit elevated at 23 which is the number we look for for dehydration sometimes the kidneys , but it's not terrible . um so when i look at your numbers as a whole i think you're tolerating the torsemide okay at the current dose . i also sent out to look at the heart failure number- i sent to look at your heart failure number . there is a test called a bmp that i was monitoring and in march it was up to 3,000 and then went up to 6,000 in april before i made the change . i'm still waiting for those results .
698
doctor: all in all i think you're doing good on paper though . patient: what about , um what's it called , a1c ? does that show up ?
D2N025
16
[ "Lab Examination" ]
[ "Objective" ]
all in all i think you're doing good on paper though .
699