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you want to carry share sure yeah we can switch
[ "Chitchat" ]
[ "Null" ]
500
and how have those numbers been
[ "Personal History" ]
[ "Subjective" ]
501
okay . is her twin a boy or a girl ?
[ "Family History" ]
[ "Subjective" ]
502
okay . all right . and , uh , are you ... did they see a reason , as to why it was elevated ?
[ "Personal History" ]
[ "Subjective" ]
503
okay , and for social history can you tell me what you do for work ?
[ "Other Socials" ]
[ "Subjective" ]
504
okay and do you feel any sort of tightness in the back of your neck or in your shoulders or you know you said it's in the back of your head primarily any discomfort anywhere else
[ "Acute Symptoms" ]
[ "Subjective" ]
505
you take it everyday okay do you notice that you're urinating any less recently
[ "Vegetative History" ]
[ "Subjective" ]
506
yeah well i guess you're gon na have to watch that
[ "Discussion" ]
[ "Plan" ]
507
hi frank how are you i heard the medical assistant told me that you're having some shortness of breath
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
508
thc gummies from grandma that's an excellent grandmother that you have okay have you noticed any swelling stiffness tenderness
[ "Acute Symptoms" ]
[ "Subjective" ]
509
yeah , you're welcome . let me know if you have any questions .
[ "Discussion" ]
[ "Plan" ]
510
but i would consider you as someone that would make me a little bit concerned . i have had healthy people die from covid .
[ "Discussion" ]
[ "Plan" ]
511
do you have any questions , hannah ?
[ "Discussion" ]
[ "Plan" ]
512
all right . it all looks good . go ahead and sit up . so , in terms of getting that pressure down , you're on three meds that are maxed out and your blood pressure is still not down . and , the question is what do we need to do to get your- to get it down . uh , your potassium one week ago was 4.0 . uh , has it been redone since in the last week ?
[ "Physical Examination" ]
[ "Objective" ]
513
i'm gon na give him the same medicine as his sister , and just hang onto it , um , just to watch and see . if this was a monday and we had a whole week to watch , i would say to just call us if things got worse , um , but since , um , if it's gon na be the weekend , and things might worsen tonight or tomorrow night , i'd rather you have just what you need on hand .
[ "Follow-up", "Medication" ]
[ "Plan" ]
514
okay . so , maybe it's a couple times a month you feel this way ?
[ "Acute Symptoms" ]
[ "Subjective" ]
515
okay alright well let's go ahead and refer you to physical therapy if you're still having pain then we might have to consider an mri
[ "Discussion", "Diagnostic Testing", "Referral" ]
[ "Plan" ]
516
alright now do you have that pain when you lay on your back as well or just on your left side
[ "Acute Symptoms" ]
[ "Subjective" ]
517
okay . all right . and is it one knee versus the other ? or both equally ?
[ "Acute Symptoms" ]
[ "Subjective" ]
518
uh , but keep working hard on , on pt in the meantime though .
[ "Discussion", "Referral" ]
[ "Plan" ]
519
hmmm sure i'll prescribe demerol
[ "Discussion" ]
[ "Plan" ]
520
okay and when does it does it happen every time you eat
[ "Acute Symptoms" ]
[ "Subjective" ]
521
okay and everything's working out well with the protonix ?
[ "Therapeutic History" ]
[ "Subjective" ]
522
so your blood sugar is a little bit high , it was 169 today but that kind of depends on what you ate and you were n't fasting for the blood check so i might have to repeat that test for pre-op , but i do n't think we need to do it today .
[ "Lab Examination" ]
[ "Objective" ]
523
i'm doing pretty good hey i see here in the nurse's notes it looks like you hurt your left ankle can you tell me a little bit more about that
[ "Acute Symptoms" ]
[ "Subjective" ]
524
okay . and any tingling or numbness ?
[ "Acute Symptoms" ]
[ "Subjective" ]
525
yeah it should help with the healing of your elbow it's just a procedure we'll stick a needle in your elbow
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
526
okay alright so i'll see you again soon okay
[ "Chitchat" ]
[ "Null" ]
527
so tell me what brings you in today .
[ "Acute Symptoms" ]
[ "Subjective" ]
528
you can stop the ibuprofen .
[ "Discussion", "Medication" ]
[ "Plan" ]
529
20 to 30 miles on a road bike ?
[ "Personal History" ]
[ "Subjective" ]
530
great . so mister i would like to do a physical exam if that's okay with you
[ "Physical Examination" ]
[ "Objective" ]
531
all right-y . and any difficulties with your pregnancy with her or during delivery ?
[ "Family History" ]
[ "Subjective" ]
532
okay now have you had any other symptoms like fever chills drainage from the wound or anything along those lines
[ "Vegetative History" ]
[ "Subjective" ]
533
okay , so the nurse will come in and she'll go over all that stuff with you .
[ "Chitchat" ]
[ "Null" ]
534
okay so for your diabetes it's gon na be very important to get your diabetes under control in order to get the wound to heal so we might even go ahead and get a diabetic consult so that we can go over some some maybe some ways you can modify your diet without a being too much but maybe that can bring down your hemoglobin a1c into a little bit better level okay
[ "Referral", "Other Treatments" ]
[ "Plan" ]
535
okay and i'm gon na move it around so when i look at the knee there is no redness there's no swelling i can appreciate a a small amount of effusion and that means that there's a little bit of fluid under the knee or in that knee's joint space and there is there is several reasons that could be now when i push on your knee does it hurt more on the inside or does it hurt more on the outside here
[ "Physical Examination" ]
[ "Objective" ]
536
okay so have you ever hurt your left foot before
[ "Personal History" ]
[ "Subjective" ]
537
just the knees . and have you noticed any swelling of your knees , or any redness of your knees ?
[ "Vegetative History" ]
[ "Subjective" ]
538
okay . anything else i should be aware of or that we should be checking ?
[ "Acute Symptoms" ]
[ "Subjective" ]
539
all right . so , i'm gon na take a look at your ankles and feet . i'm just gon na look for some swelling .
[ "Physical Examination" ]
[ "Objective" ]
540
and how many months have you been participating in weight watchers ?
[ "Other Socials", "Vegetative History" ]
[ "Subjective" ]
541
it's usually pretty well tolerated have you ever had any trouble with your stomach
[ "Personal History" ]
[ "Subjective" ]
542
um , and your abdomen also feels a little tender . you have some tenderness of the palpation of the right lower quadrant , but other than that , your heart sounds nice and clear and your lungs are clear as well . so let's go ahead and take a look at some of your results , okay ?
[ "Physical Examination" ]
[ "Objective" ]
543
yeah we'll probably do a fasting blood sugar we'll we'll order the hemoglobin a1c that should n't be actually matter because that checks long term but if we need your blood sugar may be elevated today i i would n't be surprised alright and i forgot to examine your back by the way so on your back exam you do have some tenderness in the paraspinal areas of your back in the in the lower back mostly no midline tenderness you have good reflexes so i think this is all muscular pain right now for your back pain i'm gon na go ahead and put you on some naprosyn and some flexeril which is a muscle relaxer i'm gon na give you some exercises you can do to help you get off the couch it'll also help your blood sugar and why do n't we have you if that does n't work the the pain medicine and the physical we can start physical therapy and see if that helps okay
[ "Discussion", "Medication", "Diagnostic Testing" ]
[ "Plan" ]
544
good . okay . so , you know , the last time we spoke , you know , you were trying to think of some new strategies to manage your depression . you did n't wan na go on medication because you're already on a bunch of meds .
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
545
wow that's pretty bad does it keep you up at night
[ "Acute Symptoms" ]
[ "Subjective" ]
546
yeah , okay .
[ "Acute Symptoms" ]
[ "Subjective" ]
547
doctor: alright
[ "Chitchat" ]
[ "Null" ]
548
well a a pill box or maybe setting an alarm on your phone might really help
[ "Discussion", "Medication" ]
[ "Subjective", "Plan" ]
549
yeah . it always is . how about one , one , one eight-ounce cup a day ? okay ?
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
550
okay , great . why do n't you come with me , we'll get the tech to put the cast on .
[ "Chitchat" ]
[ "Null" ]
551
okay . any weight loss ?
[ "Vegetative History" ]
[ "Subjective" ]
552
hmmm yeah i'm not a big cat person
[ "Chitchat" ]
[ "Null" ]
553
okay so pain on palpation both on the bony process and on the muscle can you move your neck from side to side can you move your neck can you swive it side to side no no alright so i'm i'm seeing i'm seeing some range of movement moderate range of movement that's fine okay i so when can you bend your neck forward that that's your whole body just just the neck are you capable of bending up
[ "Physical Examination" ]
[ "Objective" ]
554
okay well so where does it hurt like in on the inside or the outside or
[ "Acute Symptoms" ]
[ "Subjective" ]
555
good morning julie how are you doing this morning
[ "Greetings" ]
[ "Subjective" ]
556
yeah you know be sure you're staying well hydrated you know six to eight glasses of water per day is a good good idea and you you know when when it warms up you're certainly gon na prespire more and lose lose more fluid so so i would i would recommend that you continue to have you know a a standard six to eight glasses of of fluid intake per day but yeah that you know that should do it and if you're feeling particularly dehydrated you might wan na increase that if you have an increased activity level so alright any other questions for me
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
557
okay . i- i know that we had given you some clobetasol for your scalp . is that- so that's doing okay ?
[ "Therapeutic History" ]
[ "Subjective" ]
558
okay and you said you lift a lot of weights
[ "Other Socials" ]
[ "Subjective" ]
559
okay . all right . well , i wan na go ahead and do a quick physical exam , all right ? hey , dragon , show me the vital signs . so , your vital signs here in the office look quite good .
[ "Physical Examination" ]
[ "Objective" ]
560
you are welcome , have a good rest of your day .
[ "Chitchat" ]
[ "Null" ]
561
. and they showed that . so , how are you doing with that ?
[ "Personal History" ]
[ "Subjective" ]
562
yeah what what are you doing with your basement are you are you doing like a a man cave or
[ "Chitchat" ]
[ "Null" ]
563
yeah those those trails are great there's like five miles of regular flat trails and then there's a bunch of hiking trails that they've opened up as well it's a really great place man you guys need to get out there we'll get you fixed up and we'll get you back out there okay
[ "Chitchat" ]
[ "Null" ]
564
alright so go ahead and do a quick exam on your knee here so when i press here does that hurt
[ "Physical Examination" ]
[ "Objective" ]
565
okay so you are positive for pain to palpation you do note that moderate tenderness of the medial epicondyle now i'm gon na have you turn your wrist as if you're turning a door knob do you have any pain when you do that
[ "Physical Examination" ]
[ "Objective" ]
566
okay . all right , and how are you doing with your psoriasis ?
[ "Personal History" ]
[ "Subjective" ]
567
uh , digoxin ?
[ "Therapeutic History" ]
[ "Subjective" ]
568
okay . but you're not hurting right now ?
[ "Physical Examination" ]
[ "Objective" ]
569
so do you have anything any other questions for me
[ "Discussion" ]
[ "Plan" ]
570
okay . so , i know that we've kind of talked about holding off on medical therapy-
[ "Discussion" ]
[ "Plan" ]
571
yeah and you're it's just you're weak are is it
[ "Acute Symptoms" ]
[ "Subjective" ]
572
no it did n't help alright did you hear anything pop or anything like that when
[ "Acute Symptoms" ]
[ "Subjective" ]
573
okay alright i'm gon na do a couple of other other maneuvers here for your knee so on your left knee exam i do appreciate some edema you also have some effusion some fluid in the knee you have moderate range of motion so you're able to move it a little bit but not all the way i also see you have some pain on flexion and extension of the knee even negative lachman's test and a negative valgus and varus test as well so all that to say is i do n't think anything is is torn in your knee based on the your physical exam so we did do a x-ray of your left knee and luckily it was normal so there is no fractures no bony abnormalities so everything is good there so let me talk to you little bit about my assessment and plan for your knee okay
[ "Physical Examination", "Radiology Examination" ]
[ "Objective" ]
574
and throat looks fine no tonsils
[ "Acute Assessment" ]
[ "Assessment" ]
575
you did not okay okay what are you doing for the pain today
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
576
okay alright but no chest pain right now no shortness of breath no sweats or clamminess or anything like that right now
[ "Vegetative History" ]
[ "Subjective" ]
577
um , any changes in , um , weight gain or anything like that ?
[ "Personal History" ]
[ "Subjective" ]
578
okay and what have you taken for the pain
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
579
hey matthew how're you doing
[ "Greetings" ]
[ "Subjective" ]
580
lastly , once we get your knee surgery , um we , we should think about getting you a colonoscopy . we can do it here locally because you have medicare . do you have private insurance also ?
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
581
hey , dragon . um , order medications and procedures as discussed . all right .
[ "Chitchat" ]
[ "Null" ]
582
okay well very good well i will be following up with you soon and again just take it easy for now from the running okay
[ "Chitchat" ]
[ "Null" ]
583
okay like a prednisone taper pack that type of thing
[ "Therapeutic History" ]
[ "Subjective" ]
584
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 ?
[ "Physical Examination" ]
[ "Objective" ]
585
okay alright and then so how's the pain with your knee on a scale of one to ten one being the least pain ten being the worst pain how's how's it been ranging
[ "Acute Symptoms" ]
[ "Subjective" ]
586
okay alright and did the ski patrol give you crutches i i see you have them here with you okay alright great and are you otherwise generally healthy
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
587
okay . all right . well , let's talk about your , your kidney transplant . how are-
[ "Personal History" ]
[ "Subjective" ]
588
okay and you might even just keep a log of what your blood pressures are and when it's up think about you know what you've eaten if you've done something different because that may help you to figure out what you need to cut back on or how you might need to change your your eating habits a little bit so
[ "Other Treatments" ]
[ "Plan" ]
589
what about bruising ?
[ "Acute Symptoms" ]
[ "Subjective" ]
590
okay . all right . hey , dragon . i am seeing mrs. anderson , a 44-years-old female , uh , complaining to check the left shoulder pain . um , so how long how has this lasted ?
[ "Acute Symptoms" ]
[ "Subjective" ]
591
yeah . mildly dry skin , no skin breakdown . l- let me know if you can feel this .
[ "Physical Examination" ]
[ "Objective" ]
592
. a couple of , like couple months ago . that's been fine ?
[ "Personal History" ]
[ "Subjective" ]
593
correct , it's not a steroid .
[ "Discussion", "Medication" ]
[ "Plan" ]
594
that's also good for your kidneys , so everything , everything good ... is good there . your third problem is your depression . been a rough year . some of that's just normal reactive stuff . so i think we'll just keep you where you are at . not going to change the zoloft . do you need a refill on your zoloft ?
[ "Reassessment", "Discussion", "Medication" ]
[ "Assessment", "Plan" ]
595
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 .
[ "Discussion", "Medication" ]
[ "Plan" ]
596
okay . great . all right . and then , you know , how about your reflux ? we had placed you on , um , omeprazole , you know , to help with some of those symptoms and i know that you were gon na do some dietary modifications . how are you doing with that ?
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
597
i would recommend calling your primary care and discuss that with him since he follows you for your blood pressure and cholesterol .
[ "Discussion" ]
[ "Plan" ]
598
all right so your ears look good , a little bit of wax on both sides . can i see inside your mouth ? big ahh .
[ "Physical Examination" ]
[ "Objective" ]
599