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okay so you think it's been going on longer okay alright now how about have you had any burning when you urinate at all
[ "Vegetative History" ]
[ "Subjective" ]
700
i'm good .
[ "Chitchat" ]
[ "Null" ]
701
that we had too much , yeah .
[ "Discussion", "Medication" ]
[ "Plan" ]
702
diane is a 28 year old female with a past medical history , significant for , depression and hypertension who presents for emergency room follow-up . so diane what's going on ? i heard that your- your blood pressure was really high in the emergency room . what happened ?
[ "Personal History" ]
[ "Subjective" ]
703
it's nice to meet you . i'm dr. miller .
[ "Chitchat" ]
[ "Null" ]
704
nausea or vomiting , changes in bowel movements ?
[ "Vegetative History" ]
[ "Subjective" ]
705
sure now for your next problem of your hypertension i wan na go ahead and order a lipid panel on you and i think i do wan na increase i do wan na increase the lisinopril to forty milligrams once a day just to get your blood pressure under better control and we'll see how you do on the forty milligrams once a day for your third problem of your diabetes let's go ahead and order a hemoglobin a1c and just to make sure that we do n't have to make any adjustments to your metformin how does that sound
[ "Medication", "Diagnostic Testing", "Reassessment" ]
[ "Assessment", "Plan" ]
706
uh , lastly for your third problem for your hypertension i'm gon na go ahead and order an echocardiogram just to recheck it . just that heart murmur . and i'm going to go ahead and keep the lisinopril at 20 milligrams a day . do you have any questions ?
[ "Reassessment", "Discussion", "Diagnostic Testing", "Medication" ]
[ "Assessment", "Plan" ]
707
and so in order to reduce the size of the breast , we have to take out both the fat and the glands . so it just depends on how much is left , whether you can breastfeed in the future . and then also , the breast will change over time . if you , um , gain weight , they will get larger , things like that .
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
708
okay . all right . and in terms of your depression , how are you , how are you doing ?
[ "Personal History" ]
[ "Subjective" ]
709
okay and when you when you got it would you have any trauma to your foot or it just just did it pop up all of a sudden
[ "Personal History" ]
[ "Subjective" ]
710
okay . i do feel stool in your lower colon , which would coincide with constipation , but i also feel a slight enlargement of your liver here on the upper right side . have you had any lab work done recently ?
[ "Physical Examination" ]
[ "Objective" ]
711
okay have you ever taken any daily medications for your asthma an inhaler or singulair or anything like that
[ "Therapeutic History" ]
[ "Subjective" ]
712
for your blood sugar check are you checking that or not really
[ "Personal History" ]
[ "Subjective" ]
713
okay okay good good you know it's hard to stay away from the sugary foods sometimes i i enjoy ice cream regularly okay so let's do physical exam as long as you are here so i'm just gon na listen to your heart your heart sounds normal no murmurs or gallops listen to your lungs quick if you can take a deep breath lungs are clear that's good news let's take a look at that knee right knee looks like it definitely has some swelling i'm gon na do some maneuvers here does it hurt when i push you on the inside of the knee
[ "Physical Examination" ]
[ "Objective" ]
714
okay yeah so like that your brother does n't either
[ "Family History" ]
[ "Subjective" ]
715
okay great so if you do n't have any other questions i'm gon na have the nurse check you out and get all that scheduled and i'm gon na see you in about three weeks
[ "Chitchat" ]
[ "Null" ]
716
okay well first of all i i agree with you the weather has kinda been all over the place been hot and been cold and and and now it seems like we've had a week of pretty chilly weather hopefully that changes pretty soon so tell me a little bit about when when your back pain started and and and what happened there
[ "Personal History" ]
[ "Subjective" ]
717
sure we can do that and so okay but you are still taking that twenty milligrams per day correct
[ "Personal History" ]
[ "Subjective" ]
718
well do n't , do n't get crazy with the pickle juice because all of the salt in it .
[ "Chitchat" ]
[ "Null" ]
719
i'd like to tell dax about you , okay ?
[ "Chitchat" ]
[ "Null" ]
720
alright so hey it's nice to see you jack i know you've been experiencing some neck pain could you tell me what happened
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
721
okay now the other thing
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
722
my gosh the the pang ones are on fire you know they beat up on new york seven to two i mean the hockey's just an amazing sport i i just do you guy do you do a lot of hockey down there in town here
[ "Chitchat" ]
[ "Null" ]
723
and then i will get you a referral to physical therapy something that you can do close to home or close to work and then maybe i could see you back here in maybe four to six weeks and recheck this
[ "Discussion", "Follow-up", "Referral" ]
[ "Plan" ]
724
have you ever had any type of injury to that knee i mean did you fall or bump it against something or
[ "Personal History" ]
[ "Subjective" ]
725
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
[ "Vegetative History" ]
[ "Subjective" ]
726
hey dragon , order the medications and the procedures . all right , why do n't you come with me and we'll get you signed out ?
[ "Chitchat" ]
[ "Null" ]
727
okay . have you- ... go ahead .
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
728
okay now let's talk just briefly about your pain so if you have n't taken anything at all or have you been taking anything at all let's start with that have you been taking anything for the pain
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
729
okay . and it seems like it's worse at night ?
[ "Acute Symptoms" ]
[ "Subjective" ]
730
hey good to see you philip so i see here you're coming in you had some right elbow pain also you have a past medical history of hypertension diabetes we are gon na check up on those as well so can you tell me what happened to your elbow
[ "Acute Symptoms", "Personal History", "Greetings" ]
[ "Subjective" ]
731
hey , dragon , show me the vital signs . so , here in the office today , your vital signs look great . your blood pressure is fine . your heart rates r- right where it should be , which is good , okay ? i'm just gon na do a quick exam . and i'll let you know what , what i find , okay ?
[ "Physical Examination" ]
[ "Objective" ]
732
okay , and that's the 250/50 dose , correct ?
[ "Therapeutic History" ]
[ "Subjective" ]
733
okay , that's good . and your masked face , though , it does look thinner .
[ "Acute Symptoms" ]
[ "Subjective" ]
734
no belly pain
[ "Vegetative History" ]
[ "Subjective" ]
735
mm-hmm
[ "Vegetative History" ]
[ "Subjective" ]
736
okay alright
[ "Vegetative History" ]
[ "Subjective" ]
737
okay , so you got my letter last time on the results . your sugars are not very well controlled .
[ "Personal History" ]
[ "Subjective" ]
738
and is it hurt- ... tender right around that area ?
[ "Acute Symptoms" ]
[ "Subjective" ]
739
okay . did you have a nice holiday ?
[ "Acute Symptoms" ]
[ "Subjective" ]
740
okay and what have you taken for the pain
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
741
okay . and if you stay still , do you feel better ?
[ "Acute Symptoms" ]
[ "Subjective" ]
742
okay alright and so do do you go to the trampoline park often
[ "Other Socials" ]
[ "Subjective" ]
743
mm-hmm .
[ "Personal History" ]
[ "Subjective" ]
744
okay great thanks so carolyn tell me about your headache and headache or headaches when did when did they start and and what symptoms are you having
[ "Acute Symptoms" ]
[ "Subjective" ]
745
so let's just go ahead and we'll- we're going to go over , you know , my assessment and my plan for you . so for your first problem , your back pain . you know , i think you have a lumbar strain from the lifting . so , let's go ahead . we can prescribe you some meloxicam 15 mg once a day .
[ "Acute Assessment", "Medication" ]
[ "Assessment", "Plan" ]
746
and are you also taking the full dose of the hydrochlorothiazide ? do you have any , um , chest tightness or pressure or any shortness of breath ?
[ "Therapeutic History", "Vegetative History" ]
[ "Subjective" ]
747
okay and are and do you still have pain down there in your lower back
[ "Acute Symptoms" ]
[ "Subjective" ]
748
okay and that's when you get the pain more
[ "Personal History" ]
[ "Subjective" ]
749
wow okay alright so yeah you you definitely have decreased that so that's again good for you on that one so hopefully you keep you keep that up
[ "Chitchat" ]
[ "Null" ]
750
okay and have you had any numbing or tingling in your fingers at all
[ "Acute Symptoms" ]
[ "Subjective" ]
751
okay sure any pain with urination or any blood in your urine
[ "Vegetative History" ]
[ "Subjective" ]
752
okay and what do you mean by bigger pieces of food like what's your diet like
[ "Personal History" ]
[ "Subjective" ]
753
any questions ?
[ "Discussion" ]
[ "Plan" ]
754
valgus stress medial collateral ligament intact lateral collateral ligament intact okay so little kind of little laxity posterior drawer let me see the other let me see the other knee
[ "Physical Examination" ]
[ "Objective" ]
755
alright so you are positive for pain with resistance against flexion of that left wrist so i let let's go ahead and review the x-ray that we did of your elbow the good news is i do n't see any fracture or bony abnormality of that right elbow which is good so let's talk a little bit about my assessment and plan for you so for the problem with elbow pain i do believe that this is consistent with medial epicondylitis which is caused by the overuse and potential damage of those tendons that bend that that bend the wrist towards the palm now i want you to rest it i'm gon na order a sling and i want you to wear the sling while you're awake now we're also gon na have you apply ice to the elbow for twenty minutes three times a day and i want you to take ibuprofen that's gon na be six hundred milligrams q.6 h. with food and i want you to take that for a full week now you're not gon na like this part but i want you to hold off for the next couple of weeks on doing any type of pottery work okay alright now what i wan na do is i wan na see you again in a week and i wan na see how you're doing okay
[ "Follow-up", "Medication", "Other Treatments", "Radiology Examination", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
756
doctor: all right . hey , dragon . finalize the note .
[ "Chitchat" ]
[ "Null" ]
757
hi keith , how are you ?
[ "Greetings" ]
[ "Subjective" ]
758
alright is it the inside or outside of your elbows
[ "Acute Symptoms" ]
[ "Subjective" ]
759
alright have you ever had this type of back pain before
[ "Personal History" ]
[ "Subjective" ]
760
and that's about it . do you have any questions for me ?
[ "Discussion" ]
[ "Plan" ]
761
hi teresa what's going on i heard that i heard that you're having a sore throat you're not feeling well
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
762
has n't really stayed put ?
[ "Personal History" ]
[ "Subjective" ]
763
hi , martha . how are you ?
[ "Greetings" ]
[ "Subjective" ]
764
abdominal pain ?
[ "Vegetative History" ]
[ "Subjective" ]
765
okay . and i know you had the , uh , bypass grafting last year . you're doing okay ?
[ "Personal History" ]
[ "Subjective" ]
766
okay . and any fever or chills ?
[ "Acute Symptoms" ]
[ "Subjective" ]
767
yeah definitely so yeah so you you can limit the activities for sure in terms of your work activities i know if you sit too long sometimes it can be painful because you do need to move that leg a little bit so it does n't lock up so i i would like for you to you know do do some slight activities not enough to stress your legs but definitely move move them a little bit every now and then so it does n't lock up on you okay
[ "Discussion", "Referral" ]
[ "Plan" ]
768
okay any numbness any tingling
[ "Acute Symptoms" ]
[ "Subjective" ]
769
um , but i think , um , i think that's been under control . but if it flares up go ahead and , uh , give me a call , okay ?
[ "Discussion", "Follow-up" ]
[ "Plan" ]
770
and how often do you have a bowel movement when you are constipated ?
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
771
you do n't really seem that excited
[ "Chitchat" ]
[ "Null" ]
772
frequently
[ "Personal History" ]
[ "Subjective" ]
773
okay , i see .
[ "Family History" ]
[ "Subjective" ]
774
okay . and , um , so you're still taking the lisinopril ?
[ "Therapeutic History" ]
[ "Subjective" ]
775
okay and and has work been not hard lately you've been busy it sounds like
[ "Other Socials" ]
[ "Subjective" ]
776
and how's your weight been ? any fluctuation ?
[ "Vegetative History" ]
[ "Subjective" ]
777
shortness of breath
[ "Acute Symptoms" ]
[ "Subjective" ]
778
okay . watch for low sugars , weak , shaky , sweaty . if that happens , let us know , and i do n't expect it to .
[ "Discussion" ]
[ "Plan" ]
779
does that sound like a plan ?
[ "Chitchat" ]
[ "Null" ]
780
okay let me come around let me lift up the left side if i lift that up does that cause
[ "Physical Examination" ]
[ "Objective" ]
781
that is n't very nice you gon na have to show her that that's not very nice you're gon na have to teach her a lesson
[ "Other Socials" ]
[ "Subjective" ]
782
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
[ "Discussion", "Medication", "Reassessment" ]
[ "Assessment", "Plan" ]
783
um , and doxycycline can give you bad upset stomach or heartburn . um , it will make you sunburn , even if you never sunburn , so you have to protect yourself .
[ "Medication" ]
[ "Plan" ]
784
okay alright now are you a pretty active person you said you were skiing do you do what kind of other activities do you do
[ "Other Socials" ]
[ "Subjective" ]
785
and any surgeries in the past ?
[ "Personal History" ]
[ "Subjective" ]
786
okay . great . i'm glad to hear that . now , i know you did a review of systems sheet when you checked in .
[ "Chitchat" ]
[ "Null" ]
787
doctor: hey , dragon , finalize the note .
[ "Chitchat" ]
[ "Null" ]
788
do you or do you like going to colorado
[ "Chitchat" ]
[ "Null" ]
789
that but yeah go ahead
[ "Therapeutic History" ]
[ "Subjective" ]
790
okay but you're never really pain free is that what i hear you saying
[ "Acute Symptoms" ]
[ "Subjective" ]
791
okay , squeeze my finger here . good . can you feel me touch out here ?
[ "Physical Examination" ]
[ "Objective" ]
792
okay got it and how about your blood pressure how has that been running at home are you checking your blood pressures daily still and how how your how how have your blood pressures been
[ "Personal History" ]
[ "Subjective" ]
793
okay . on physical examination everything looks good . you know your lungs are nice and clear . your heart sounds good . you know you do have some weakness of your lower extremities . the right is about 4 out of 5 , the left is about 3 out of 5 . but you reflexes are really good so i'm , i'm encouraged by that . and you do have some , you know , arthritic changes of the right knee .
[ "Physical Examination" ]
[ "Objective" ]
794
okay alright and have you noticed any other joint pain like in your elbows or shoulders or anything like that that since this started
[ "Acute Symptoms" ]
[ "Subjective" ]
795
okay , sure . and , are you right or left-handed ?
[ "Personal History" ]
[ "Subjective" ]
796
it's not very expensive and i can just call it into your pharmacy
[ "Chitchat" ]
[ "Null" ]
797
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
[ "Vegetative History" ]
[ "Subjective" ]
798
you do n't check it at all okay that's that's okay i i looked at it here we will talk about that in a minute and are you taking the lisinopril i think we have you on twenty milligrams a day
[ "Therapeutic History" ]
[ "Subjective" ]
799