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[Vegetative History][Doctor] okay , all right . and how about , um , like any added sugars into any kind of processed foods or anything like that ? [Patient] uh , i think most of my sugars come from fruit .[SEP][Vegetative History][Doctor] from what ? [Patient] fruit .[SEP][Chitchat][Doctor] fruit , okay . [Patient] yeah .[SEP][Acute Symptoms][Doctor] all right . um , and have you been feeling sick recently ? have you had any fever or chills ? [Patient] uh , i have not .[SEP][Acute Symptoms][Doctor] body aches , joint pain ? [Patient] uh , a bit of joint pain .[SEP]
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[Personal History][Doctor] no okay and have you ever had a tick bite before [Patient] i have when i was younger i used to get a lot of them because i spent a lot of time out of the woods never get into anesthesia takes you can get several bites out of that but this was just one[SEP][Personal History][Doctor] okay alright and have you ever been diagnosed with what we call lyme disease before [Patient] i have not[SEP][Personal History][Doctor] you have not [Patient] i would n't know so i would n't know what symptoms are[SEP][Vegetative History][Doctor] yeah so some of those symptoms like any flu like symptoms have you had like any body aches or chills or anything like that [Patient] no just really just kind of a a headache just generally do n't feel well[SEP]
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[Chitchat][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[SEP][Vegetative History][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[SEP][Physical Examination][Discussion][Medication][Radiology Examination][Referral][Diagnostic Testing][Acute Assessment][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[SEP][Follow-up][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[SEP][Follow-up][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[SEP]
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[Acute Symptoms][Doctor] and an ace wrap okay now how many days ago was this exactly [Patient] seven[SEP][Personal History][Therapeutic History][Doctor] seven days ago okay yeah your right knee still looks a little swollen for seven days ago so i'm gon na go ahead and now i also see that you're diabetic and that you take five hundred milligrams of metformin twice a day are you still you're still on that medication is that correct [Patient] correct[SEP][Personal History][Doctor] and do you check your blood sugars every morning at home [Patient] every morning[SEP][Physical Examination][Doctor] okay great and since this i'm the reason i'm asking all these questions i'm a little concerned about the inactivity with your your knee pain and you know how diabetes you need to be very you know active and and taking your medicine to keep that under control so you know may wan na continue to follow up with your pcp for that diabetes as we go through here and just watch your blood sugars extra as we go through that now i'm gon na go ahead and examine your your right knee and when i push on the outside does that hurt at all [Patient] no[SEP][Physical Examination][Doctor] okay and when i push on this inside where it's a little swollen does that hurt [Patient] yes[SEP]
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[Chitchat][Doctor] i'm good . uh , are you ready to get started ? [Patient] yes .[SEP][Acute Symptoms][Doctor] okay . so , janet is a 33-year-old female , here for some , some joint paint . what , what joint's been bothering you , janet ? [Patient] it's been mostly , um , my knees , actually . i've been doing more stair type workouts , which i thought was , you know , building muscle , uh , on my knees and supposed to help .[SEP][Acute Symptoms][Doctor] mm-hmm . [Patient] but in turn it , it really has n't , so my knees have been really bothering me .[SEP][Acute Symptoms][Doctor] okay . all right . and is it one knee versus the other ? or both equally ? [Patient] it's both equally .[SEP][Acute Symptoms][Doctor] okay . and have you been having any other joint pain like , elbows or shoulder , or anything like that ? [Patient] no , but i , i should mention that like , i had a rotator cuff repair about two years ago .[SEP]
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[Therapeutic History][Doctor] i'm sorry to hear that . and- and what did you do about the second dose ? [Patient] well , i called into the hotline because i was in so much pain with the first one . and they said , " no , just go ahead and take it , " so i did .[SEP][Discussion][Diagnostic Testing][Doctor] okay . that's good then . we do have to keep an eye out on it since it's a high-risk medication . do you have an appointment to get your blood drawn for the next time ? [Patient] no , they did n't give me one .[SEP][Discussion][Doctor] okay . so we can do that for you too . uhm , so what questions do you have for me , judy ? [Patient] well , i just wanted to know why i was getting all these bruises here , so like when i bump myself . i do n't know where they're coming from .[SEP][Discussion][Doctor] okay . that's probably from the prednisone , it can increase bruising . [Patient] okay . i did n't know that . um , i do n't even feel it when it happens , they just show up .[SEP][Discussion][Doctor] yeah . unfortunately that can happen , but we're working on discontinuing that so let's see if the bruises do go away . [Patient] okay . that sounds good , thanks .[SEP]
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[Personal History][Doctor] okay . um , it looks like you had a history of atopic eczema in your past ? [Patient] yes . yes , i have eczema .[SEP][Personal History][Therapeutic History][Doctor] okay . and you take uh- uh , fluocinonide for that ? [Patient] yes , when it gets really itchy , i'll- i'll use that and it usually takes care of it .[SEP][Personal History][Doctor] okay . and , it looks like you have a pre- previous surgical history of a colectomy ? what happened there ? [Patient] yes , i had a- um , some diverticulosis and then um , i actually went into diverticulitis and they ended up going in and having to remove a little bit of my colon .[SEP][Physical Examination][Doctor] okay , let me examine you . does it hurt when i push on your leg like that ? [Patient] yes , it does .[SEP][Physical Examination][Doctor] okay . if i lift your leg up like this , does that hurt ? [Patient] no .[SEP]
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[Other Socials][Doctor] okay well are you still wearing those same shoes that cause the problem [Patient] no i'm upset[SEP][Chitchat][Doctor] i'm so upset too i love those shoes [Patient] no i'm so upset i i love those shoes[SEP][Other Socials][Doctor] okay so what kind of shoes are they [Patient] they're hoka's[SEP][Other Socials][Doctor] ah so where did you get them [Patient] i got them at rei couple of years ago[SEP][Chitchat][Doctor] they're pretty good about helping you to fit your fit you in a shoe are n't they [Patient] yeah[SEP]
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[Physical Examination][Doctor] okay . you can go ahead and , um , sit down please . no pain ? [Patient] no .[SEP][Physical Examination][Doctor] okay . sacroiliac signs are negative . examination of the hips . trochanteric is non tender . go ahead and lift your knee up , does that bother you ? [Patient] um , just a little bit .[SEP][Physical Examination][Doctor] okay , little bit . and then back one , probably bothers you ? [Patient] right there , like there , yeah .[SEP][Physical Examination][Doctor] okay . how about this way ? not too bad ? [Patient] no .[SEP][Physical Examination][Doctor] okay . range of motion is decreased in right hip with pain in the groin and internal and external rotation . okay , go ahead and keep it up , do n't let me push it down . does that hurt ? [Patient] right there .[SEP]
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[Physical Examination][Doctor] okay then . i'm going to be using my status post template , ms. sanchez , please lie down on the table here and we'll get started . all right . can you turn your head to the left . head and neck no jvd detected . you can turn back now and just take a couple of deep breaths for me please . okay , that's good . and lungs have reduced breath , but auscultation and percussion are clear . okay . breath normally , i'm just going to listen to your heart . rhythm is irregularly irregular . [Patient] that's a funny statement . what does that mean ?[SEP][Physical Examination][Doctor] yeah , it does sounds kind of weird , right ? it's when your heart does n't beat with the correct rhythm , and whatever rhythm it does n't have a pattern to it . so , it's part of the atrial fibrillation . [Patient] wow , that sounds like a mess .[SEP][Physical Examination][Doctor] yeah , it's not ideal . but , many people have a-fib are able to keep it under control with medicine and lifestyle changes . [Patient] agh , i see . that's good to know .[SEP][Physical Examination][Doctor] okay . so , s1 slightly accentuated , no s3 . i'm going to touch your belly , and does any of that hurt . [Patient] nope .[SEP][Physical Examination][Doctor] how about there ? and your feet ? [Patient] no , not really .[SEP]
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[Acute Symptoms][Doctor] okay and when does it does it happen every time you eat [Patient] it hurts not every time it hurts when i when i swallow most foods but it's really just the bigger pieces of food that seem like they're getting stuck[SEP][Personal History][Doctor] okay and what do you mean by bigger pieces of food like what's your diet like [Patient] well things have been stressed over the last couple of months so lacks a moving from the west coast of east coast so i've been drinking more eating things like pizza burgers i know it's not good but you know it's been pretty busy[SEP][Other Socials][Doctor] wow that sounds kinda stressful like what are you moving for [Patient] well i'm stressed because what i'm moving because you know i i do n't like the west goes so i i decided to move but you know it's just stressful[SEP][Other Socials][Doctor] okay so are you thinking of driving [Patient] i i think so i think i'm i think i'm gon na end up driving but that's still a a long trip[SEP]
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] |
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] | 210
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[Diagnostic Testing][Doctor] all right , well , let's just repeat it then . [Patient] yeah , that's fine with me , to be safe .[SEP][Discussion][Diagnostic Testing][Doctor] okay . i know it sounds superstitious , but i feel like with all the immunocompromising , the pressure , the stress that people's bodies have been under , and the potential for getting covid or the vaccine ... i have actually seen some , um , an increase in abnormal paps in people who have been fine for a while . so that's why i figure let's just check . [Patient] okay . i fight the vaccine fight every day at home because my husband is n't ready to get it . same with my daughter . she shares the same worries as her dad in how it'll impact her when she gets older .[SEP][Therapeutic History][Doctor] have you had the vaccine ? [Patient] yes , i have . and so has my son . he , um , has had his first already .[SEP][Chitchat][Doctor] okay . well , you know , you can only do what you can do . [Patient] yeah , i agree .[SEP][Chitchat][Doctor] all right . well , let's complete your exam . [Patient] all right .[SEP]
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[Conversation Start][SEP][Greetings][Doctor] patient is julia jones , date of birth 5/16/1996 . she is a new breast reduction consult . hello , how are you doing today ? i'm dr. gonzalez . it's nice to meet you . [Patient] nice to meet you , ma'am . how are you ?[SEP][Acute Symptoms][Doctor] i'm doing good , thank you . so you're here to discuss a breast reduction , correct ? [Patient] yes . that's right .[SEP][Personal History][Doctor] okay . perfect . let me just get logged in , here . have you met with anyone before about a breast reduction ? [Patient] no , i have n't .[SEP][Personal History][Doctor] okay . and how long have you been considering this ? [Patient] it's probably been about six or seven years . but i mean , it's always been in the back of my mind .[SEP]
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[Acute Symptoms][Doctor] wow okay and do you know if there was any direct or associated trauma that you can think of over the past three weeks like did you fall or hit your shoulder or anything [Patient] no no trauma that i can think of at all[SEP][Personal History][Doctor] okay now have you ever had pain in that shoulder before [Patient] you know i'm active and will have aches and pains here and there but nothing that some tylenol ca n't take care of[SEP][Acute Symptoms][Doctor] okay and and it's isolated to your left shoulder [Patient] it is[SEP][Physical Examination][Doctor] okay are you able to move that left arm for me [Patient] you know anytime i try reaching for something or lifting anything i have a lot of pain and i do n't even try to raise my arm over my head because that's it it really hurts[SEP]
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[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] hi , bryan . how are you ? [Patient] i'm doing well . i'm a little sore .[SEP][Chitchat][Doctor] all right , well , i know the nurse told you about dax . i'd like to tell dax a little bit about you , okay ? [Patient] that's fine .[SEP]
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[Conversation Start][SEP]
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[Conversation Start][SEP]
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[Chitchat][Doctor] i'm doing okay . so i know the nurse told you about dax . i'd like to tell dax a little bit about you . [Patient] all right .[SEP][Personal History][Doctor] so , anna is a 44-year-old female with a past medical history significant for arthritis , gout , and reflux , who presents today for follow up of her chronic problems . so , anna , it's been probably about six months since i've seen you . how are you doing ? [Patient] i'm doing okay . um , my arthritis is starting to get better . um , i've been trying to move my body , doing pilates , lifting weights , um , and that's , kind of , helped me build up some muscle , so the joint pain is , has been going away .[SEP][Personal History][Doctor] okay . yeah . i know you were having , you know , some problems with your right knee , uh , and we sent you for physical therapy . so , so that's going well ? [Patient] yeah . the physical therapy's gone really well . i've built up my strength back and it's been really great .[SEP][Personal History][Doctor] okay . so you feel like you're able to walk a little bit further now ? [Patient] yup . i'm walking about a mile , a mile and a half a day .[SEP][Personal History][Doctor] okay . great . that's good . i'm glad to hear that . okay . and then , in terms of your gout , um , how are you doing with that ? i know you had an episode of gout of your , your right first big toe , um , about two months ago . how are you doing with that ? [Patient] i'm doing , doing well . the medication helped it , you know , go down and go away . hopefully , , it does n't come back .[SEP]
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[Chitchat][Doctor] okay what kind of rides do you like [Patient] i like rock music and regain music rides so whoever is doing those in a began or a medium content i'm cool with[SEP][Acute Symptoms][Doctor] i ca n't picture you as a regade person so that's interesting to know okay alright and any numbing or tingling in your foot at all [Patient] yes but not from the knee injury i broke my foot my second toe on my right foot and i have numbness depending upon the shoe i wear[SEP][Personal History][Doctor] okay when did you break your toe [Patient] i've broken it three times over the last ten years so it's just something that's a an annoyance but it was n't caused by this injury[SEP][Personal History][Doctor] okay so you do have some numbing and tingling but it's not new [Patient] right correct[SEP][Physical Examination][Doctor] alright alright well let's just go ahead and i'm gon na go ahead and do a quick physical exam i'm gon na be calling out my exam findings i'll let you know what that means so on your musculoskeletal exam on your right knee i do appreciate some slight edema you do have a slight effusion does it hurt when i press on the outside of your knee [Patient] no not physically[SEP]
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[Physical Examination][Doctor] okay , great . all right well i'm just going to look at your ankles and feet , i'm looking for any signs of swelling . [Patient] okay .[SEP][Discussion][Other Treatments][Reassessment][Doctor] all right , well everything looks good . you can go ahead and sit up miss taylor . all right , so the good news is everything is looking okay . i think we both agree if you were able to stop drinking your blood pressure would cease to be an issue for you . [Patient] yeah i agree with that .[SEP][Discussion][Doctor] so let us discuss the potential medicine to help you with that . what it does is it blocks some of the brain receptors that alcohol stimulates and it tricks the brain into thinking it does not need alcohol , thereby cutting down the urges . [Patient] the urge to drink or the constant thinking about it ?[SEP][Discussion][Medication][Doctor] it actually will help with both . [Patient] okay . so is it like a one-time thing ?[SEP][Discussion][Medication][Doctor] generally the shot is given about once a month , it can also be given as a daily pill , but the shot does tend to work a bit better . [Patient] yeah i've taken things like this in the past and if it is a pill , i know i wo n't take it . with a shot , it's not like you can un-take it .[SEP]
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[Lab Examination][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 .[SEP][Lab Examination][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 .[SEP][Lab Examination][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 ?[SEP][Discussion][Diagnostic Testing][Doctor] um i do n't think i ordered it but i could . your last a1c was 5.5 in march . [Patient] all righty .[SEP][Lab Examination][Doctor] 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 . [Patient] all righty that sounds good .[SEP]
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[Greetings][Doctor] okay good morning [Patient] good morning thanks doctor doctor cooper i'm i'm you know i'm a little i'm sad to be in here but you know thanks for taking me in i appreciate it[SEP][Discussion][Doctor] sure absolutely what can i help you with today [Patient] so you know i've been dealing with my asthma and like i tried to join sports but it's really kind of it's getting hard you know and i i i just wonder if there's something that can be done because i really do like playing water polo and then like i'm kind of a little bit worried i think my mood is getting a little a little worrisome and i i wanted to explore like what my options were[SEP][Therapeutic History][Doctor] okay let's talk about the asthma first so what inhaler are you using now [Patient] i have an albuterol inhaler[SEP][Acute Symptoms][Doctor] okay and when when you're having trouble it's usually just around sports that is it keeping you up at night [Patient] so i do n't really like wake up at night a lot typically like it's sports like you know if i'm doing anything like crazy aerobic or like running or anything i do notice that if any if i'm around smoke i do start coughing a little bit but most of the time it's sports[SEP][Acute Symptoms][Doctor] okay and can you describe a little bit for me what happens [Patient] i start to yeah no so i start to feel like there is like some phlegm building up in my in my throat and i start coughing like my chest gets tight i start wheezing and i just have to sit down or else i'm gon na get like lightheaded too[SEP]
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[Discussion][Doctor] okay how long is the vacation [Patient] it's only for like a couple weeks[SEP][Discussion][Doctor] okay well so you might have to postpone it just because depending on what physical therapy says right if they feel that you can sustain if you can like sustain the exercises while you're gone that if there's something that you can do by yourself then you should be fine but we do wan na give it you said that it's gon na happen in a couple of weeks [Patient] no vacation in a month[SEP][Discussion][Follow-up][Doctor] okay okay yeah so how about in a month we come you come back let's do a checkup again see where we are at and then we can assess whether or not this is something that i would recommend you do [Patient] that sounds good thank you[SEP][Chitchat][Doctor] no problem bye [Patient] bye[SEP]
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[Acute Symptoms][Personal History][Doctor] so logan is a 57-year-old male , with a past medical history significant for coronary artery bypass grafting , hyperlipidemia , and ocd , who presents with an upper respiratory infection . so , logan , what's going on ? [Patient] so , uh , about a week ago i started to get a cold . and , in the last two or three days , it seemed to move into my chest .[SEP][Acute Symptoms][Doctor] okay . um , and , and are you having any pain in your sinuses ? or , any post nasal drip ? [Patient] um , i had some post nasal drip for , again , for the beginning of the week . and then , uh , it , it left my , uh , my head . it went right down to my upper , uh , chest .[SEP][Therapeutic History][Personal History][Doctor] okay . and have you gotten vaccinated against covid ? [Patient] i actually have . i've , uh , gotten both vaccines .[SEP][Chitchat][Doctor] okay . all right . [Patient] on both , both stages .[SEP][Family History][Doctor] okay . and anyone else sick as far as you know ? [Patient] no , not in my house . no .[SEP]
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[
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"Vegetative History"
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"Subjective"
] | 223
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[Personal History][Vegetative History][Doctor] okay . have you- ... go ahead . [Patient] actually it has n't changed at all . much of the same .[SEP][Personal History][Vegetative History][Doctor] okay and what do you con- consider the same ? are you eating lots of sugar ? like , teas and coffees and- [Patient] i do n't take sugar with my tea .[SEP][Vegetative History][Doctor] okay , all right . and how about , um , like any added sugars into any kind of processed foods or anything like that ? [Patient] uh , i think most of my sugars come from fruit .[SEP][Vegetative History][Doctor] from what ? [Patient] fruit .[SEP][Chitchat][Doctor] fruit , okay . [Patient] yeah .[SEP]
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[Greetings][Doctor] hi , alexander . how are you ? [Patient] i'm doing really well . thank you .[SEP][Chitchat][Doctor] so , i know the nurse told you a little bit about dax . i'd like to tell dax about you . okay ? [Patient] sure .[SEP][Therapeutic History][Personal History][Doctor] so , alexander is a 62-year-old male , with a past medical history significant for reflux , who presents for follow-up of his chronic problems . so , alexander , what's being going on ? [Patient] well , i am so thankful you put me on that medicine for my , my reflux .[SEP][Drug History][Doctor] the protonix ? [Patient] the protonix . that , i had , w- made an amazing change in my life .[SEP]
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[
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[Acute Symptoms][Doctor] okay alright [Patient] sometimes i walk there is[SEP][Acute Symptoms][Therapeutic History][Doctor] okay alright have you done anything to help with the pain [Patient] well i wear a brace and i have used a lot of thc cream on it[SEP][Acute Symptoms][Therapeutic History][Doctor] okay alright thc cream is an interesting choice but do you think that's been helpful [Patient] yes[SEP][Acute Symptoms][Therapeutic History][Doctor] alright have you taken [Patient] reasons[SEP][Acute Symptoms][Therapeutic History][Doctor] not a problem have you taken any medications [Patient] no just gummies[SEP]
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[
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"Therapeutic History"
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[Acute Symptoms][Doctor] mm-hmm [Patient] and i hit in the back and like my my neck went forward and my head went forward really quick and so i've been having some pain ever since[SEP][Acute Symptoms][Doctor] okay and so with this pain how long ago was the car accident [Patient] that was about a week ago[SEP][Acute Symptoms][Doctor] okay with this pain like on a scale of one to ten how severe is it [Patient] i would say it's about a seven[SEP][Acute Symptoms][Doctor] alright so where exactly is it on the side on the back [Patient] it's in the back of my neck[SEP]
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[
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[Discussion][Doctor] okay . so , i know that we've kind of talked about holding off on medical therapy- [Patient] mm-hmm .[SEP][Discussion][Doctor] . 'cause you're on so many other meds . [Patient] mm-hmm .[SEP][Discussion][Doctor] um , is that something that you wan na revisit , or do you wan na look into therapy , or do you think anything's needed right now ? [Patient] uh , i think i probably wan na shy away from any therapy . my , my wife got me into meditation recently and , and , uh , i , i find that relaxing . so , i think i'd like to continue that , at least for a couple more months and see how it goes .[SEP][Physical Examination][Doctor] okay . all right . that sounds good . all right . well , i know the nurse did a quick review of systems with you , when you- [Patient] mm-hmm .[SEP][Vegetative History][Doctor] . checked in . do you have any symptoms , any chest pain or shortness of breath ? [Patient] none whatsoever .[SEP]
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] |
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] | 228
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[Acute Symptoms][Doctor] okay alright [Patient] i think that was my left knee[SEP][Acute Symptoms][Doctor] okay okay alright so we got we got ta pick one if it if it [Patient] i'm just trying to be real[SEP][Acute Symptoms][Doctor] a hundred percent so how about this right now you're like i what i'm hearing is that you're experiencing bilateral knee pain like both of your knees hurt but i'm assuming that like your right knee hurts more is that correct [Patient] yeah my left knee does n't really hurt[SEP]
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[Other Socials][Doctor] okay okay okay how so do you have any other exercises that i might wan na know about outside of intense gym and ski events [Patient] no i think that's about it[SEP][Other Socials][Doctor] okay and how frequently do you normally ski [Patient] i ski probably three times a week[SEP][Therapeutic History][Doctor] okay and then are you on any medications at this time other than the thc [Patient] no[SEP][Chitchat][Doctor] okay alright what [Patient] nothing no[SEP]
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[Personal History][Doctor] martha is a 50-year-old female with a past medical history significant for congestive heart failure , depression and hypertension who presents for her annual exam . so , martha , it's been a year since i've seen you . how are you doing ? [Patient] i'm doing well . i've been traveling a lot recently since things have , have gotten a bit lighter . and i got my , my vaccine , so i feel safer about traveling . i've been doing a lot of hiking . uh , went to washington last weekend to hike in northern cascades, like around the mount baker area .[SEP][Chitchat][Doctor] nice . that's great . i'm glad to hear that you're staying active , you know . i , i just love this weather . i'm so happy the summer is over . i'm definitely more of a fall person . [Patient] yes , fall foliage is the best .[SEP][Personal History][Doctor] yeah . um , so tell me , how are you doing with the congestive heart failure ? how are you doing watching your diet ? i know we've talked about watching a low sodium diet . are you doing okay with that ? [Patient] i've been doing well with that . i resisted , as much , as i could , from the tater tots , you know , the soft pretzels , the salty foods that i , i love to eat . and i've been doing a really good job .[SEP][Personal History][Therapeutic History][Doctor] okay , all right . well , i'm glad to hear that . and you're taking your medication ? [Patient] yes .[SEP][Personal History][Doctor] okay , good . and any symptoms like chest pains , shortness of breath , any swelling in your legs ? [Patient] no , not that i've noticed .[SEP]
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] | 231
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[Acute Symptoms][Doctor] 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 [Patient] my headache started about a week ago it's feeling like a dull pain in the back of my head i have flushing in my ears they get really red and hot and sometimes i just feel a little bit dizzy when i get these headaches but i've taken tylenol and advil and it's not really going away it just keeps coming back[SEP][Acute Symptoms][Doctor] okay and alright and so this started about a week ago has it been fairly constant since it started or does it come and go does it come and go or what [Patient] it comes and goes i it it's relieved when i take my tylenol or advil but then it comes right back[SEP][Acute Symptoms][Doctor] hmmm okay and do you notice any any timing difference you know is it is it worse in the morning worse in the evening is there anything else that makes it better or worse [Patient] it's definitely worse in the evening[SEP][Acute Symptoms][Doctor] 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 [Patient] yes no just in the back of my head[SEP][Acute Symptoms][Doctor] okay and did the headache start all of a sudden carolyn or has it been gradual or what [Patient] i've been under a lot of stress lately so maybe about when some stress started occurring[SEP]
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"Acute Symptoms"
] |
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] | 232
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[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] hey alan i good to see you today so i looked here my appointment notes and i see that you're coming in you had some shoulder pain left shoulder pain for the last three weeks so how you doing is it is it gotten any better [Patient] yeah yeah i've been having a lot of pain of my shoulder for the last three weeks now and it's not getting better[SEP][Acute Symptoms][Doctor] okay do you remember what you were doing when the pain first started [Patient] so i i was thinking that i i ca n't recall like falling on it injuring it getting hit[SEP][Acute Symptoms][Doctor] okay so do you remember hitting it or anything like that [Patient] no nothing at all[SEP]
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] |
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[Radiology Examination][Doctor] let's look at your x-rays . uh , they look good . so here's what you got going on in there . uh , it looks good . everything's lined up nicely . um , that's looking at it from the front . and this is looking at it from the side . and then this was underneath your kneecap , but we did n't do anything there . but things looks great . [Patient] okay . i'm so happy with how the surgery went . i have no pain .[SEP][Discussion][Referral][Reassessment][Doctor] yeah , you know , you're still early in your recovery , so i expect you to get even better than what you are now . um , so keep doing your pt to work on your strength , range of motion , and endurance . [Patient] okay , will do .[SEP][Discussion][Doctor] you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well . [Patient] okay . that's really good to know . thank you .[SEP][Follow-up][Doctor] yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay . [Patient] sure , okay . and can i ask you about work before i go ?[SEP]
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[Personal History][Doctor] okay , that sounds good . [Patient] but i was taking it twice a day and i did notice a lotta improvement .[SEP][Vegetative History][Doctor] i see . um , are you breastfeeding at this time ? [Patient] no , i'm not right now .[SEP][Vegetative History][Doctor] okay , good . so you- you should not be breastfeeding while you're on that medication . [Patient] yeah , actually i stopped breastfeeding and then asked for the doxycycline at that time .[SEP][Vegetative History][Doctor] okay . even with the doxycycline , you can keep using the elidel . [Patient] okay . and i did n't take the elidel because when i read about it i got worried . so i wanted to just try the doxycycline and see .[SEP]
|
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] | 235
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[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] so gloria is a 46 -year-old female today with past medical history of diabetes and back pain and today here for shortness of breath with chf and copd also so gloria tell me what's going on [Patient] i i i'm having a lot of trouble sleeping[SEP][Acute Symptoms][Doctor] okay and and how long has this been going on for [Patient] really just for about the past two weeks i i just ca n't ca n't get comfortable you know when i when i lay down in bed i just ca n't ca n't fall[SEP]
|
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] |
[
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] | 236
|
[Personal History][Doctor] yeah and that can happen and one of those things that causes that is that those intake of that fatty foods which is you know kind of the the keystone or the hallmark of the keto diet and have you noticed any improvement when you do cut out that fatty food and has that been difficult since you are watching your carb intake [Patient] the fatty food it is a little bit difficult you know i like those pork grinds and you know i i've had to kind of cut those out they were a nice staple for me when i was on the keto diet but i have cut out the those pork rinses because those were just so delicious and you know i would say it's a little bit better but i still get that pain[SEP][Family History][Doctor] okay and then do you have any family history of gallbladder disease [Patient] yeah but you know you know i knew that was coming both my dad and my mother both had gallbladder disease and had to have their gallbladders off[SEP][Family History][Doctor] okay so both both your parents your mom and your dad had your had their gallbladders taken out [Patient] yeah[SEP]
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] | 237
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[Conversation Start][SEP][Greetings][Doctor] hi evelyn , how are you ? [Patient] i'm good , how are you ?[SEP][Chitchat][Doctor] i'm good . it's good to see you . [Patient] good to see you too .[SEP][Chitchat][Doctor] so i know the nurse told you a little bit about dax . i'm gon na tell dax about you , okay ? [Patient] okay .[SEP][Personal History][Doctor] so evelyn is a 56-year-old female with a past medical history significant for coronary artery disease , prior carpal tunnel release , and a herniated disc who presents for her annual exam . so evelyn it's been a little while since i've seen you , how have you been doing over the last year ? [Patient] i've been doing okay , um , everything , um , with my herniated disc in my back has been doing really well . i have n't had any , um , back pain , or any , um , limitations in movement , so that's been doing well .[SEP]
|
[
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] |
[
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] | 238
|
[Conversation Start][SEP][Greetings][Doctor] uh , mrn49282721 . patient's name is jacqueline miller . use last visit exam where appropriate . hi , how are you doing , jacqueline ? [Patient] i'm pretty . good . how are you ?[SEP]
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[Personal History][Doctor] so do you have any other medical conditions [Patient] no i'm actually other than that i just had my physical and i'm not taking any medications no i'm i'm pretty good otherwise[SEP][Family History][Doctor] okay and what conditions would you say run in your family [Patient] i have high blood pressure diabetes and depression[SEP][Physical Examination][Discussion][Diagnostic Testing][Acute Assessment][Lab Examination][Doctor] okay alright so let me go ahead and do a quick physical exam on you so i reviewed your vitals and everything looks good and on general appearance you appear to be in no distress no jaundice on the skin on your heart exam you have a nice regular rhythm rate regular rate and rhythm with a grade two out of six systolic ejection murmur is appreciated on your lung exam your lungs are clear without wheezes rales or rhonchi on your abdominal exam bowel sounds are present your abdomen is soft with no hepatosplenomegaly yes let me i will change that one splenomegaly and on your muscle exam there is no gait disturbance or edema so i did we i was able to review your your results of your recent lab work and your hcv antibody test was positive so your your liver panel we did one of those and it showed an elevated ast at thirty nine but your alt albumin and total bilirubin were all within normal limits so that's pretty good so let's talk a little bit about my assessment and plan for you so you do have hepatitis c so your initial labs were consistent with that hep c diagnosis and so you know i do n't know if you read much about hep c but hepatitis c is a viral infection that does affect your liver and you've most likely had it for several years now it it it most patients do n't see symptoms until years later so the next step that i would like to do is just confirm the diagnosis with some additional blood work so that includes checking your hep c rna and your hcv genotype and i would also like to determine the severity of your liver disease by checking for fibrosis of the liver and we will do that by ordering an ultrasound elasto elastography with this information we will we we will be able to know how we can proceed as far as treatment right so how does that sound [Patient] i hmmm so i do have a wife and kids so should i be worried about them[SEP][Discussion][Diagnostic Testing][Follow-up][Doctor] okay yeah so we can start with the same screening that you had for august first so we'll just let's do that hep c antibody test and i'll actually help you set up those appointments with your your family doctor and then we can just see you back in three weeks and based on the results you know we will take action as needed okay [Patient] okay that sounds good[SEP][Chitchat][Doctor] alright [Patient] alright[SEP]
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] | 240
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[Other Socials][Doctor] wow that's that's a that's an aggressive campaign to get there so really hope you get that triathlon in so you're how many days a week does this occur that you're training [Patient] i i do that five days a week on the weekends i kinda alternate between you know a long run and a long bike do n't really do a long swim but[SEP][Other Socials][Doctor] okay on your running days or when you do the running tell me a little bit about your stretching routine do you are you aggressive stretchers you do not stretch at all i know people that do both [Patient] yeah i do n't i do n't stretch at all i do n't have time for that[SEP]
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] |
[
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] | 241
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[Conversation Start][SEP][Greetings][Doctor] um , hi mrs. anderson . right ? [Patient] yeah . yes , doctor .[SEP][Acute Symptoms][Doctor] what brings you here today ? [Patient] hi , doctor . um , i'm having this left shoulder pain lately , uh , and it's paining a lot .[SEP][Acute Symptoms][Doctor] 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 ? [Patient] it's been a week , doctor . yeah .[SEP][Acute Symptoms][Doctor] a week . [Patient] yeah .[SEP]
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[
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"Therapeutic History"
] |
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] | 242
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[Vegetative History][Doctor] and how's your weight been ? any fluctuation ? [Patient] nice and pretty stable , although i could stand to lose about 25 pounds .[SEP][Family History][Doctor] okay . and is there any family history of gi issues that you know of ? [Patient] not that i can think of . well , actually my sister does have problems with her stomach too . she has irritable bowel syndrome and that is kind of what i always thought i had even thought i've never been diagnosed with it .[SEP][Family History][Doctor] okay . and is there any family history of gi cancer or liver disease ? [Patient] nope .[SEP][Personal History][Doctor] have you ever had any surgeries on your abdomen ? [Patient] i've never had any surgery .[SEP][Personal History][Doctor] okay , so your gallbladder , appendix , all those are still intact ? [Patient] yup .[SEP]
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[
"Personal History"
] |
[
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] | 243
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[Conversation Start][SEP][Greetings][Doctor] hi , stephanie . how are you ? [Patient] i'm doing okay . how are you ?[SEP][Chitchat][Doctor] i'm doing okay . um , so i know the nurse talked to you about dax . i'd like to tell dax a little bit about you , okay ? [Patient] okay .[SEP][Acute Symptoms][Personal History][Doctor] so , stephanie is a 49-year-old female with a past medical history significant for congestive heart failure , kidney stones and prior colonoscopy who presents today for an abnormal lab finding . so , stephanie , i called you in today because your hemoglobin is low . um , how have you been feeling ? [Patient] over the past couple of months , i've been really tired and dizzy . lately , i've been really just worn out , even just , you know , walking a mile or going to work , doing things that i've done in the past every day that have been relatively okay , and i have n't gotten tired . and now , i've been getting tired .[SEP][Acute Symptoms][Personal History][Vegetative History][Doctor] okay , yeah . i , you know , the nurse told me that you had called with these complaints . and i know that we have ordered some labs on you before the visit . and it did , it c- you know , your , your , your hemoglobin is your red blood cell count . and now , and that came back as a little low on the results , okay ? so , have you noticed any blood in your stools ? [Patient] uh , no , i have n't . i did about three years ago , um , and i did a colonoscopy for that , but nothing since then .[SEP]
|
[
"Acute Symptoms",
"Vegetative History"
] |
[
"Subjective"
] | 244
|
[Therapeutic History][Doctor] and so by inhaler do they mean both your daily and rescue inhalers ? [Patient] mm-hmm . so it's like they'll have a fitness test and basically they'll tell me not to take my inhaler that day before the test , and then they'll see how the asthma affects me . and they're looking to see if it's serious enough to hold me back from joining or whatever . so i have been taking it less and less . and really some days i feel like i do n't need it .[SEP][Therapeutic History][Doctor] and that is the wixela that you're not taking . so on average per week , how many days of the week do you use one puff in the morning and one puff at night ? [Patient] probably about three or four .[SEP][Therapeutic History][Doctor] okay , three to four days per week and the other days it's once a day ? [Patient] yes , that's correct .[SEP][Therapeutic History][Doctor] okay , and do you think that's working okay ? [Patient] i do .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 245
|
[Therapeutic History][Doctor] okay alright yeah because i think we really want you to stay away from that those anti-inflammatories because that can make your kidney function worse and obviously you know we do n't wan na see you go on dialysis or anything like that so we'll have [Patient] mean neither[SEP][Personal History][Doctor] right so we'll have to you know really work on that now tell me a little bit about are you watching the potassium and stuff in your diet [Patient] nobody's really talked to me about that so[SEP][Vegetative History][Doctor] okay yeah so you want [Patient] i did n't know what high potassium foods are[SEP][Vegetative History][Doctor] okay i'm sorry i've never talked to you about that in the past i that's my fault so yeah so you wan na make sure you stay away from things like bananas oranges you know potatoes have lots of potassium that type of thing and so you know because with your kidney function you know that can cause your potassium levels to go up because you do n't get rid of the potassium as you should you know [Patient] something to eat[SEP][Vegetative History][Doctor] what's that [Patient] is there anything left is there anything left over that i ca n't eat[SEP]
|
[
"Referral",
"Other Treatments"
] |
[
"Plan"
] | 246
|
[Physical Examination][Doctor] i would like you to follow my finger here and i see that you're following my finger in in both directions can you show me your teeth . that looks nice and symmetric i'm gon na rub my fingers next to your ear can you hear that [Patient] yep[SEP][Physical Examination][Doctor] you can hear it on the other side as well [Patient] yep[SEP][Physical Examination][Doctor] okay i'm gon na take this cotton tape and run it along the side of your face can you feel that okay [Patient] yeah it's a little bit numb on my right side not so much on my left side[SEP][Physical Examination][Doctor] okay alright i'm gon na use this little needle here and i'm gon na poke here and i wan na see if you feel like it's being sharp or dull on that part of your face does that feel different or normal [Patient] it feels a little bit dull on my left on my right side my left side it feels sharp[SEP][Radiology Examination][Doctor] alright good well i had a chance to look at your mri [Patient] okay[SEP]
|
[
"Acute Assessment",
"Radiology Examination"
] |
[
"Assessment",
"Objective"
] | 247
|
[Conversation Start][SEP][Personal History][Greetings][Doctor] judy gomez , mrn 869723 . date of birth , 5 , 7 , 1961 . she's in office today for ongoing management of psoriatic arthritis . hello , judy , how are you doing today ? [Patient] i'm doing good , thank you . how are you ?[SEP][Personal History][Therapeutic History][Doctor] i'm great , thanks . so how have you been since the last time ? i know the last time we were talking about decreasing your prednisone dose , correct ? [Patient] yes . i'm just on one now and that seems to be enough .[SEP][Therapeutic History][Doctor] aw , that's great to hear . [Patient] yeah , there were a couple days there i took an extra one , just because there was a little extra pain in my feet . and i do have a desk job , so when i have a day off where i'm moving around a lot they do tend to hurt a bit more .[SEP][Therapeutic History][Doctor] okay . how many times did you do that ? [Patient] um , it was n't often , maybe once a week .[SEP]
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[
"Therapeutic History"
] |
[
"Subjective"
] | 248
|
[Personal History][Doctor] okay . and have you noticed bleeding from anywhere ? [Patient] i have not . i have n't hurt myself in quite a while . maybe a slight nick from a knife while chopping some onions , but nothing more than that .[SEP][Vegetative History][Doctor] but no blood in your stools or- [Patient] no .[SEP][Vegetative History][Doctor] . anything like that ? [Patient] no .[SEP][Vegetative History][Doctor] okay . and any type of weight loss or decreased appetite or night sweats ? coughs ? [Patient] uh , s- slightly decreased appetite , but i wish i had some weight loss .[SEP][Vegetative History][Doctor] um , okay . and how about any abdominal pain ? fever , chills ? [Patient] uh , none of that .[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 249
|
[Lab Examination][Doctor] so , not only , you know , have your blood sugars , were they high that one day , they were , they've been a little elevated . [Patient] mm-hmm .[SEP][Discussion][Doctor] so , we'll talk about , you know , how to go ahead and , and fix that . okay ? so , let me talk a little bit about my assessment and my plan for you . [Patient] mm-hmm .[SEP][Medication][Acute Assessment][Doctor] so , for your first problem , this hyperglycemia , you know , i wan na go ahead and increase your lantus to 20 units at night . okay ? i want you to continue your monitor your blood sugar and let me know how they're running 'cause we might have to adjust that further . [Patient] mm-hmm .[SEP][Discussion][Follow-up][Diagnostic Testing][Doctor] okay ? um , and i wan na order another hemoglobin a1c in a couple months . hey , dragon . order a hemoglobin a1c . for your next problem , your depression , i think you're doing a great job with your current strategies with the meditation . we will hold off on medication or therapy at this time , and you know to call me if you need anything , right ? [Patient] mm-hmm .[SEP][Referral][Reassessment][Doctor] okay . and for your third problem , your kidney transplant , your kidney function looks stable . uh , i'm gon na just have you go back to dr. reyes , to manage all of your immunosuppression medications . [Patient] okay .[SEP]
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"Referral"
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] | 250
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[Lab Examination][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 .[SEP][Lab Examination][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 ?[SEP][Discussion][Diagnostic Testing][Doctor] um i do n't think i ordered it but i could . your last a1c was 5.5 in march . [Patient] all righty .[SEP][Lab Examination][Doctor] 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 . [Patient] all righty that sounds good .[SEP][Lab Examination][Doctor] i checked your magnesium level because sometimes you uh urinate out magnesium with the water pills but it was normal at 1.7 and your blood pressure is also looking good . [Patient] okay great . that all sounds awesome .[SEP]
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[Conversation Start][SEP][Greetings][Doctor] elizabeth , how are you ? [Patient] i'm doing okay . how are you ?[SEP][Chitchat][Doctor] doing okay . so i know the nurse told you about dax . i'd like to tell dax a little bit about you , okay ? [Patient] okay .[SEP][Personal History][Doctor] all right . elizabeth is a 66-year-old female with a past medical history of significant for depression and hypertension who presents for her annual exam . so elizabeth , it's been a year since i've seen you . [Patient] mm-hmm .[SEP][Acute Symptoms][Doctor] how are you doing ? [Patient] i'm doing well . there's been so many events now that we've been able to get vaccinated , i've been able to see my grandkids again , go to more birthday parties , it's been fantastic .[SEP]
|
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] |
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] | 252
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[Acute Symptoms][Doctor] okay great alright and since you had this knee pain any numbing or tingling in your foot at all [Patient] no just the swelling and the pain[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and what have you taken for the pain [Patient] i i took some aleve twice a day some over the counter aleve twice a day[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and [Patient] putting a cold pack on it[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and has that helped at all [Patient] yeah that's helped a fair amount it's still pretty sore though[SEP][Personal History][Doctor] okay alright well let's see have you ever had any surgeries before let me just think any surgeries i do n't see any in your in your record here [Patient] i had my tonsils out[SEP]
|
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"Physical Examination"
] |
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"Objective"
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[Acute Symptoms][Doctor] yeah , and with the diarrhea and abdomal- um , abdominal pain . [Patient] right now , i'm still having the cramping and sharp pains , so i've been avoiding heavy foods . i did have some fried chicken today , though .[SEP][Acute Symptoms][Doctor] and was everything all right after that ? [Patient] yeah , for the most part .[SEP][Acute Symptoms][Doctor] okay . remember , it's also the portion sizes . so i mean , if you eat a little and you feel fine , then that's okay . you have to just really watch the portions . [Patient] okay , good . i ca n't go out- go without some fried chicken at least once in a while .[SEP][Physical Examination][Doctor] sounds good . all right , well let's take a look at you today , and we'll do a brief physical exam . you will hear me call out some findings . i will answer any questions , and we will discuss once we have finished the exam . [Patient] sounds good .[SEP][Physical Examination][Doctor] all right . so the patient is alert and cooperative , appears stated age . all right . i'm going to listen to your heart and lungs . and lungs are clear to auscultation bilaterally . heart regular rate and rhythm . all right , so if you could just lay back for me , and i'll examine your abdomen . [Patient] okay .[SEP]
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[
"Physical Examination"
] |
[
"Objective"
] | 254
|
[Physical Examination][Doctor] okay , no tenderness . look at your right and your left and then over to the right , then go ahead and look up , then look down , and look straight ahead . range of motion is full in the neck without pain . spurling's test is negative . exam of the low back . any pain here ? [Patient] no .[SEP][Physical Examination][Doctor] okay . skin is intact , no midline tenderness to palpitation . go ahead and lean back . and lean to your right , to your left . does that hurt at all ? [Patient] no .[SEP][Physical Examination][Doctor] okay , great . and go ahead and bend forward and then come back up . and that does n't bother you ? [Patient] no . i did or do have several bulging discs .[SEP][Physical Examination][Doctor] okay . but you're not hurting right now ? [Patient] no , the weight loss has really decreased all the pain .[SEP][Physical Examination][Doctor] okay . range of motion is decreased in exertion . lateral flection without pain . any pain when i push ? [Patient] no .[SEP]
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[
"Physical Examination"
] |
[
"Objective"
] | 255
|
[Therapeutic History][Doctor] okay , all right . and are you taking your medication , are you taking the lisinopril ? [Patient] yes i am .[SEP][Therapeutic History][Doctor] okay , all right . um , so i think we had started you at a , kind of , a moderate dose , so we'll have to talk about that a little bit , okay ? [Patient] okay .[SEP][Personal History][Doctor] then in terms of your depression , how are you doing ? i know that we did n't start you on medication , since you're on a bunch of other medications . what- what are your strategies for dealing with that and how are you doing ? [Patient] so last year i started therapy and i've been going once a week and that's really helped .[SEP][Other Socials][Doctor] okay , all right , great . and how is your support system ? [Patient] really great . my boyfriend , my mom , and my brother are- are s- , amazing and they're all super close to me , so it's been , it's been good .[SEP][Vegetative History][Doctor] okay , well great . so i know you did a review of system sheet when you checked in and i know that you had the headache and the lightheadedness yesterday . do you have any other symptoms at this time , chest pain , shortness of breath , anything like that ? [Patient] uh , i have a little bit of nasal congestion , but that's just from my seasonal allergies .[SEP]
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[
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] | 256
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[Conversation Start][SEP][Greetings][Doctor] hi kyle how are you today [Patient] i'm doing well i'm just anxious about my pcp told me that i had some abnormal lab work and why she wanted me to be seen by you today[SEP][Personal History][Doctor] yeah i bet that did make you nervous i i see that she referred you for a low immunoglobulin a level is that your understanding [Patient] yeah i mean i do n't even really understand what that means but yeah that's what she told me[SEP][Chitchat][Doctor] yeah that's a mouthful [Patient] yeah[SEP][Discussion][Doctor] it it's the the one of the antibodies in your body and that that really makes that your body makes to fight infections it's a little bit low i'm happy to explain it a little bit more to you i just have a few more questions okay so let's start again here [Patient] i'll do this[SEP]
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] | 257
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[Vegetative History][Doctor] have you smoked [Patient] next maybe that i have n't[SEP][Vegetative History][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[SEP][Vegetative History][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[SEP][Chitchat][Doctor] okay you have [Patient] too many questions are you the fit[SEP][Chitchat][Doctor] i'm your doctor i have to [Patient] are you the fence you sound like the fence next question[SEP]
|
[
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] |
[
"Subjective"
] | 258
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[Discussion][Other Treatments][Doctor] so it's actually [Patient] have to be in the hospital[SEP][Discussion][Doctor] no no no no no it's actually a day surgery and you'll be able to go home the same day and then you will follow up with me here in the clinic in about a week you'll be in a cast and you will use crutches as you will not be able to use that foot for six to eight weeks after that you'll start gradually walking on your foot based on how you do so the procedure itself is not very long you will and so like since you will be able to go home that's great but you wo n't be able to drive especially since you're saying are you left handed or right handed [Patient] i'm right handed[SEP][Discussion][Doctor] yeah so your your right foot is probably your dominant one and the also the one you're supposed to drive with so no you're gon na you're gon na need somebody to take you home but what [Patient] i mean[SEP][Discussion][Doctor] mm-hmm [Patient] i really wan na keep on playing my tennis with my friends but[SEP]
|
[
"Discussion",
"Referral"
] |
[
"Plan"
] | 259
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[Physical Examination][Doctor] okay alright sorry what about on the side does that hurt [Patient] yes[SEP][Physical Examination][Doctor] okay so pain on palpation both on the bony process and on the muscle can you move your neck from side to side can you move your neck can you swive it side to side no no alright so i'm i'm seeing i'm seeing some range of movement moderate range of movement that's fine okay i so when can you bend your neck forward that that's your whole body just just the neck are you capable of bending up [Patient] really hurts it really hurts[SEP][Physical Examination][Doctor] okay it really hurts to bend forward and backwards okay alright so i'm just gon na make a little note here i do n't i do n't see any bruising i'm not noticing any swelling there is i i do n't see any laceration what [Patient] just sometimes it bruises[SEP][Vegetative History][Doctor] okay sometimes alright that's fine i i just i'm not seeing one here today so that's okay alright so with that being said i do wan na ask have you been experiencing any fatigue are you tired [Patient] well since the accident yes[SEP][Radiology Examination][Doctor] okay alright just making sure okay so this is what this is my assessment and plan this is what we are gon na do i want to be able to like we had you do an x-ray before you came in here and looking at it i'm not noticing any fracture that's a really good sign considering how many car accidents we've been in lately [Patient] it hurts it hurts[SEP]
|
[
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"Acute Assessment"
] |
[
"Assessment",
"Objective"
] | 260
|
[Therapeutic History][Doctor] 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 [Patient] i think that's what i'm taking[SEP][Therapeutic History][Doctor] okay but you do take it [Patient] yeah it's a white pill[SEP][Personal History][Doctor] okay alright yeah i'm not really sure what it looks like but okay as long as you're taking it so that's good and how about your diet are you watching your are you watching your salt intake [Patient] not really i just kinda i feel the blood pressure medicine would do what's supposed to do[SEP][Chitchat][Doctor] okay alright alright well what else is going on are you a are you a sports fan i was really sad to see that the that cincinnati bangel has lost the super bowl do you follow baseball or anything like that [Patient] no i was n't too sad about that i'm a brown span[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 261
|
[Personal History][Doctor] is that in the morning when you're fasting [Patient] yes[SEP][Therapeutic History][Doctor] and are you taking your metformin [Patient] yes yes that's along with the blood pressure medicine morning and night[SEP][Vegetative History][Doctor] okay alright so are you are you eating like late at night or anything like that [Patient] no we usually eat by six[SEP][Physical Examination][Doctor] okay okay alright well hopefully we can get you to feeling better okay so i want to do a quick physical exam really check that knee out so your vital signs look good they they look alright your temperature is ninety eight . two your pulse is seventy two respirations are sixteen blood pressure is one twenty two over seventy so that looks fine i'm gon na go ahead and take a listen to your heart and lungs so on your heart exam it's a nice regular rate and rhythm but i appreciate a slight two over six systolic ejection murmur at the left base here on your lung exam your lungs are clear to auscultation bilaterally okay now let's take a quick look at that knee so does it hurt when i press on it [Patient] no[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 262
|
[Chitchat][Doctor] well , let's talk about what we found and then some possible next steps if you're in agreement . [Patient] okay .[SEP][Acute Assessment][Doctor] so as i said , the hepatomegaly means your liver is enlarged . [Patient] could that be why my stomach is hurting and i'm having issues with the constipation and diarrhea ?[SEP][Medication][Acute Assessment][Doctor] no , i think you're constipated and have occasional bouts of diarrhea because of certain foods you eat . and we can get you started right away on a fiber supplement that should help with that . [Patient] so what about my liver ? why is it enlarged ?[SEP][Discussion][Drug History][Doctor] well , there are many reasons why people can have an elevated liver enzymes and also enlarged liver . some possible causes are certain medications that can be toxic to liver , alcohol abuse , fatty liver disease , hepatitis , cirrhosis , and other liver diseases like wilson's disease . [Patient] so what do i need to do ?[SEP][Discussion][Diagnostic Testing][Doctor] well , i think since it's been about four months since your blood work was done , we should check your liver enzymes in addition to a few other labs . [Patient] okay . and then what ?[SEP]
|
[
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] |
[
"Plan"
] | 263
|
[Personal History][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[SEP][Acute Symptoms][Physical Examination][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[SEP][Acute Symptoms][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[SEP][Acute Symptoms][Therapeutic History][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[SEP][Acute Symptoms][Therapeutic History][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[SEP]
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[Diagnostic Testing][Other Treatments][Doctor] i'm not gon na know that for sure or if there is other things going on in there but i think getting an mri scan to look at what you may have done inside there i'm pretty suspicious though that you may have injured that ligament if that's the only thing you did very rarely is this gon na need surgery okay so this may be something we wan na get you into a brace here get you into some therapy and get all your motion back and get your strength back and then maybe check it back in a in a few weeks and see because a lot of times those ligaments can tighten back up it's it's odd for just an isolated posterior ligament to need surgery [Patient] mm-hmm[SEP][Discussion][Diagnostic Testing][Other Treatments][Doctor] but if there's other things going on i ca n't tell you for sure that you did n't injure a meniscus too or maybe chipped some cartilage when that bone shifted so let's let's get an mri scan to look at that if that comes back with just a ligament like i'm suspecting hopefully this is something we can treat with some therapy and some bracing for a while and get this thing back to normal if after that couple months later or so you still have instability and still bothering you then it's possible we may have to do some surgery to fix that ligament [Patient] okay[SEP][Discussion][Doctor] does that make sense [Patient] yeah yeah so in the meantime though do you want me to still keep taking the ibuprofen[SEP][Discussion][Doctor] yeah i think that's fine for a short if it's helping the big thing right now is we want to get your strength back and your motion back get rid of the swelling that we still see here [Patient] okay[SEP][Discussion][Medication][Doctor] so that will help with that ice ice packs a few times a day you can take the ibuprofen up to three times a day and i'll look i'll we'll look at the dose here there are some other medicines we can try that maybe do n't have to take so often that may be easier [Patient] mm-hmm[SEP]
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[Conversation Start][SEP][Greetings][Doctor] hi , susan , how are you ? [Patient] good . how are you ?[SEP][Greetings][Doctor] good . are you ready to get started ? [Patient] yes , i am .[SEP]
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[
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[
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] | 266
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[Discussion][Doctor] mm-hmm . [Patient] . so , um , i hope that should n't matter , right ?[SEP][Discussion][Doctor] um , that does n't seem related to your pain . [Patient] okay .[SEP][Discussion][Doctor] so ... but i would try to rest my , your left arm- [Patient] okay .[SEP][Discussion][Doctor] . while it's healing . [Patient] okay .[SEP][Discussion][Doctor] so , um- [Patient] can i , uh , carry any heavy weights or-[SEP]
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[Other Treatments][Doctor] there is a lot of salt and pizza and you know and you're gon na have to be able to avoid all the other salty foods as well so and i know that's hard but it's very important for your heart to be able to function at it's best right and you wan na be able to get out and walk you know walk take those walks again at the park and then you know do your photography so in order to do that we're gon na have to really cut back on those okay [Patient] well[SEP][Physical Examination][Discussion][Referral][Medication][Radiology Examination][Reassessment][Doctor] alright so why do n't we go ahead and do a quick physical exam on you here i just want to take a look at you your vital signs look good i'm glad to see you're tolerating the medication well i'm gon na go ahead and feel your neck here i do n't appreciate any jugular venous distention and there are no carotid bruits on your heart exam there is a three out of six six systolic ejection murmur it's heard at the left base but that's pretty much the same as last year so we'll continue to monitor that okay let me listen to your lungs here real quick russell your lungs are clear so good good and your extremities i do n't see any swelling or edema on your right radial artery the cath site there is clean and it's dry and intact and i do n't see any hematoma so that's good and there is a palpable rra pulse so russell i did review the results of your ekg which showed normal sinus rhythm good r wave progression and evolutionary changes which are anticipated so let's go ahead and talk about my assessment plan for you for your first diagnosis of coronary artery disease we are gon na have you continue your your aspirin eighty one milligrams daily and brilinta ninety milligrams twice daily and we're gon na have you continue on that high dose statin that atorvastatin you might call it lipitor eighty milligrams daily and then also continue on that toprol fifty milligrams daily okay and i'm also going to refer you to cardiac rehab so for you to get some education about your heart and also give you the confidence to get back exercising regularly now i know patients love the cardiac rehab program i think you will do well does that sound good to you [Patient] that sounds good document[SEP][Medication][Diagnostic Testing][Reassessment][Doctor] alright so for your second diagnosis here the newly reduced left ventricular dysfunction and moderate mitral regurgitation i think your pumping function will improve in time you know they got you to the lab quickly so i think that heart muscle is just stunned and you're very compliant you're very good with your medications and following through with those so i think it will recover so that said i want you to go ahead and continue continue your lisinopril twenty milligrams a day i do n't think you need a diuretic at this time but i do want to add aldactone twelve . five milligrams daily and then you'll need to get labs next week okay and then we're gon na repeat another echocardiogram echocardiocardiogram in about two months [Patient] okay[SEP][Discussion][Reassessment][Doctor] okay and then for your hypertension your third diagnosis of hypertension i want your to take your blood pressure just like you would you know every so often and then because your blood pressures actually seem fine at this time so we will continue to monitor that and i think you will tolerate the aldactone well as well [Patient] alright sounds good document[SEP]
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] | 268
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[Conversation Start][SEP]
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[
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[
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] | 269
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[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] hey linda good to see you today so looking here in my notes looks like you you think you have a kidney stone think you've had them before and and you i guess you're having some pain and while we are here i see you i see you have a you have past medical history of hypertension diabetes and we will check up on those as well so with your kidney stone can you tell me what happened what's going on [Patient] and i've been in a lot of pain it started about i would say probably about three days ago[SEP]
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] | 270
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[Conversation Start][SEP]
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[
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[Therapeutic History][Doctor] okay , and you take that twice a day ? [Patient] yep .[SEP][Physical Examination][Discussion][Reassessment][Doctor] okay . um , uh , hey , dragon ? show me the vital signs . okay , good news here is your blood pressure's good . everything , um , there is fine . so , um , so , my assessment is , is , um , your first problem is diabetes . it's a little out of control . we'd like that hemoglobin a1c to be under seven , um , at least . you know , preferably , under six . [Patient] mm-hmm .[SEP][Discussion][Medication][Other Treatments][Doctor] so , um , uh , i'm not gon na change your medication . i think this is diet related , so i want you to try to cut down on the snacking and additional sweets , okay ? [Patient] yeah .[SEP][Discussion][Follow-up][Medication][Other Treatments][Doctor] and , i want you to check your blood sugars in the morning . i want you to call them in in about two weeks so we know what your first , um , fasting blood sugar was in the morning , and then , we'll come back and see you in about two months and see if everything has straightened out . if it has n't , then we'll talk about adding another medication , okay ? [Patient] okay .[SEP][Discussion][Medication][Reassessment][Doctor] your second problem is your hypertension . that seems to be relatively stable . i want you to stay on your current medication . you're on li- lisinopril 10 mg once a day . just stay right on that medication . no changes at this point . seems to be doing well , okay ? [Patient] okay .[SEP]
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[Personal History][Therapeutic History][Doctor] okay alright and how have your blood sugars been doing this time i know you're taking the metformin are you checking your accu-cheks how has that been going [Patient] i i'm sorry what's an accu-chek[SEP][Personal History][Doctor] for your blood sugar check are you checking that or not really [Patient] i i i did it a couple of weeks ago[SEP][Personal History][Therapeutic History][Doctor] okay so your hemoglobin a1c last time was seven . five and we had talked about you know trying to improve your diet we had talked about you know we wan na avoid going to insulin but it sounds like it's been a challenge to kinda control the diet and also your blood sugars have been running a little bit high [Patient] yeah[SEP][Personal History][Therapeutic History][Doctor] okay alright [Patient] yeah it's it's been a challenge[SEP]
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[
"Vegetative History"
] |
[
"Subjective"
] | 273
|
[Other Socials][Doctor] okay awesome alright so sorry one question did you do you have a history of playing sports [Patient] yes[SEP][Other Socials][Doctor] okay what did you play [Patient] soccer[SEP][Other Socials][Doctor] okay what position [Patient] i played midfield[SEP][Chitchat][Doctor] okay the people who hide in the back that's fine i was centered forward fine no baby do you have a team that you wrote for [Patient] you know i am a tatnham hotsper fan[SEP][Chitchat][Doctor] they have the best colors not going to lie but i i grew up manu so sorry [Patient] well i wo n't fault you for that[SEP]
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[
"Physical Examination"
] |
[
"Objective"
] | 274
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[Family History][Doctor] okay . so obstructive neuropathy . uh , it sounds like he was born with it and something , uh ... something made it so he could n't urinate correctly . does that sound right ? [Patient Guest] yes , and they did n't catch it in time .[SEP][Family History][Doctor] i'm so sorry to hear that . [Patient Guest] yeah . he actually died at 47 of a massive heart attack .[SEP][Chitchat][Doctor] my goodness . wow . i am so sorry to hear that , um , but thank you so much for ... you know , all of these bits and pieces really help knit up a story together for ashley so we can get her the best care . [Patient Guest] you're welcome .[SEP][Family History][Doctor] okay . so you said her aunt also has had kidney disease ? [Patient Guest] yes . well , it was my dad's sister , so her great aunt .[SEP][Family History][Doctor] okay . and ... okay . i'm looking here . it looks like ... do you know what the name of diagnosis ? it does n't seem to be mentioned . [Patient Guest] um , this is what she sent me , " end-stage renal disease . chronic kidney disease stage five , diabetes , hypertension . " that's all i have , uh , to work on for her .[SEP]
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[
"Family History"
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[
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[Acute Symptoms][Doctor] what can i do for you today [Patient] well i think i like fell off of my tandem bike with my partner and my knee has been hurting ever since[SEP][Acute Symptoms][Doctor] and when did that happen [Patient] maybe like two weeks ago[SEP][Acute Symptoms][Doctor] okay and which knee are we talking about [Patient] my right knee[SEP][Acute Symptoms][Therapeutic History][Doctor] alright and tell me exactly what happened [Patient] so we were like riding together and i think he said he saw a squirrel or something like that he's a little distractible and you know like he went down so i went down i hit it on the curb like it's really kinda it was sore i gave i i took some ibuprofen and i i like washed it out and put a band-aid on it but it's it's just been like kind of hurting everyday since then so i scheduled an appointment[SEP][Acute Symptoms][Therapeutic History][Doctor] okay is it getting better getting worse or just kinda lingering on [Patient] it's it's just holding on and i tried taking like medication right i took some ibuprofen and it was fine it just like it keeps coming back and i i read on the label i'm not supposed to take that stuff for more than two weeks right[SEP]
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[
"Therapeutic History"
] |
[
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] | 276
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[Conversation Start][SEP][Personal History][Greetings][Doctor] so anna good to see you today so reading here in your appointment notes you were you were diagnosed with kidney stones from your your pcp and you currently have one and so they they had you come in so can you tell me what happened how's all that going for you [Patient] sure i've been having some back pain on my right side it's been lasting for about a week now[SEP]
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[
"Personal History"
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[
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] | 277
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[Conversation Start][SEP][Personal History][Greetings][Therapeutic History][Doctor] all right . this is matthew rogers . date of birth 5/24/2007 . i would like to use the acne follow-up template for him . he is here today for an acne follow-up . at the last visit on 3/3/21 he was prescribed the following : clindamycin lotion , uh , trent- tretinoin cream , 4-5 % benzoyl peroxide wash for f-face and 5-10 % for chest and back . so we're going to enter the room : hi there , how are y'all today ? [Patient] good , how are you ?[SEP][Personal History][Doctor] i'm good , thank you . uh , acne doing better ? [Patient] yeah .[SEP]
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"Therapeutic History"
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[
"Subjective"
] | 278
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[Acute Symptoms][Doctor] okay yeah yeah a lot of my patients you know have that that minor pain so you [Patient] i'm a horrible active by the way[SEP][Vegetative History][Doctor] no yeah that's that's that's totally fine that's totally fine you know i'm just playing the doctor on tv so good good alright so have you had any other symptoms nausea vomiting anything like that [Patient] no nausea no vomiting i had some i felt like it might have been like chills but no fevers nothing along those lines[SEP][Family History][Doctor] okay that's good do you know anybody in your family that has had kidney stones in the past [Patient] yeah all in my family has had kidney stones in the past[SEP][Family History][Doctor] no well they did n't set you up good did they [Patient] yeah i i i guess i can blame them but but yeah it's been a it's been an issue with the family for as long as i've been aware of[SEP][Personal History][Doctor] okay alright and i'm reading here it looks like you've had them before as well right [Patient] i have yeah i passed some by myself and i've had to have surgery a couple of times as well[SEP]
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"Personal History"
] |
[
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[Personal History][Doctor] cataracts , yep , okay . [Patient] so he did that and then i had to wait for a month to get healed up and then he wrote my prescription .[SEP][Personal History][Doctor] perfect . and then you've got the high blood pressure . [Patient] yeah . a couple of weeks ago , it was 116 on the dot .[SEP][Therapeutic History][Doctor] okay . well , we will recheck it . you're on a combination of medications . you are on the met- met- uh , metoprolol , 50 milligrams once a day , you're on the lisinopril with hydrochlorothiazide , at 20 , with 25 milligrams once a day , and you're on the amlodipine , 10 milligram once a day . are you taking all of those ? [Patient] well , yeah .[SEP][Personal History][Therapeutic History][Doctor] perfect . and then you've got the high cholesterol and the vascular disease in your legs . you're on atorvastatin . are you tolerating it okay ? [Patient] yeah , but honestly , my feet feel like hell .[SEP]
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[
"Personal History"
] |
[
"Subjective"
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[Chitchat][Doctor] okay great [Patient] good to go[SEP][Physical Examination][Doctor] sensation is normal to the touch [Patient] yes[SEP][Physical Examination][Doctor] pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt [Patient] not as much[SEP][Physical Examination][Doctor] how about this way [Patient] not as much[SEP][Physical Examination][Doctor] alright so little bit of pain on flexion and extension little bit of limited range of motion on extension of the arm how about if you twist like you're opening a door [Patient] yes[SEP]
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[
"Physical Examination"
] |
[
"Objective"
] | 281
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[Personal History][Doctor] okay so now i see here in your record that you have some that you're diabetic and have some diabetic neuropathy as well how's your blood sugars been running i'm i'm assuming kind of all over the place over the last i'm gon na say probably three or four weeks can you tell me about that [Patient] yeah my my a1c is six point seven it's pretty well controlled[SEP][Other Socials][Doctor] okay now i know this was caused by a new pair of shoes you had mentioned before to your pcp and he relayed this to me that you really like to go on hikes you and your wife have been hiking have you gone to the new trails that that were just opened up here behind the park [Patient] yeah we actually hiked to charlie's bunion about a week before this i've had a new pair of diabetic shoes and inserts i get those every year i changed the inserts every three or four months i mean i've been in cruise control as far as that goes for some time i did get a new pair of shoes the prosthetist told me to check my feet every day for the first week or two which we did i did go hiking about the third or fourth day and i think that might be what caused it as i just went too far when we were hiking but yeah the trails are the trails are gorgeous they're open it's time to to be outside and i'm sorta stuck with this right now[SEP][Physical Examination][Doctor] absolutely yeah my wife and i like to go back there and and hike those trails as well so i'm gon na do a quick physical exam for your vital signs i do recognize a slight fever however your vitals themselves look good now on your foot exam i do recognize the necrotic wound on your heel as you mentioned it is present it's approximately two by two centimeters i i do recognize the sloughing of the of the tissue as well as what looks like cellulitis around the area as well as erythemia so now unfortunately i do also smell the odor you are correct it is it does it is odds but i do not appreciate any bony exposure now on vascular exam i do have bilateral palpable pulses femorally and popliteal pulses are present however i do n't recognize a palpable pulse dorsalis pedis or posterior tibial however i did use the doppler and they are present via doppler now i'm gon na press on the actual affected area of the wound do you have any pain there [Patient] i do n't feel that right there[SEP][Follow-up][Medication][Radiology Examination][Diagnostic Testing][Reassessment][Acute Assessment][Doctor] okay i'm gon na review the results of your right foot x-ray that we did when you came in today the good news is i do n't see any evidence of osteomyelitis meaning that there is no infection of the bone so let's talk a little bit about my assessment and plan for this nonhealing diabetic foot ulcer i'm going to order a test to check blood supply for this wound also i'm going to do a debridement today in the office we may have to look at we are going to do a culture and we may have to look at different antibiotic therapy i am concerned about the redness that's moving up your leg as well as this the the swelling and pain that you have in your calf so we're gon na monitor this very closely i wan na see you again in seven days and then as far as your diabetes is concerned i do want you to follow up with your endocrinologist and make sure that we do continue to keep your hemoglobin a1c below seven and we're gon na need to closely monitor your blood sugars since we're going to be doing some medication therapy with antibiotics and and potentially some other medications any other questions comments or concerns before i have the nurse come in we're gon na prep you for that procedure [Patient] no not really so you're gon na continue the antibiotics that i'm on and possibly extend or call in a new antibiotic depending on the culture[SEP]
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[
"Chitchat"
] |
[
"Null"
] | 282
|
[Medication][Doctor] and then i also wan na go ahead and prescribe meloxicam fifteen milligrams once a day [Patient] mm-hmm[SEP][Discussion][Doctor] to help with that do you have any questions about that [Patient] no questions[SEP][Discussion][Medication][Doctor] now if you do have a herniated disk we can go ahead and talk about some other treatment options maybe like an epidural steroid injection to help take down some of that inflammation [Patient] mm-hmm[SEP][Discussion][Medication][Doctor] it might make you feel better but we'll we'll deal with that when we get get there okay [Patient] sure[SEP][Discussion][Doctor] any questions [Patient] not at this point[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 283
|
[Physical Examination][Doctor] well let me so we're gon na have to watch that and i'll come back and we'll talk a little bit about the diabetes but let's go ahead and do that i do n't wan na do a a a quick physical exam on you i'm gon na look in your eyes here and so let me quickly look in your ears [Patient] i see[SEP][Physical Examination][Doctor] okay that looks good and any let me let me listen to your lungs okay your lungs are clear and your heart it's a regular rate and rhythm that's all good as we go through that now i want you to sit up here i'm gon na press down your back starting at the top and any pain up top no [Patient] no[SEP][Physical Examination][Doctor] okay and then once i get down here and around that low back i wan na press in the center first does that cause you a lot of pain [Patient] yeah[SEP][Chitchat][Doctor] yeah okay [Patient] yeah that that's the spot[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 284
|
[Other Socials][Doctor] that's fun very nice so you stay pretty active it sounds like [Patient] well i keep pretty active during the week yeah[SEP][Vegetative History][Doctor] okay very good good for you now tell me what what kind of foods do you like to eat [Patient] well i mean i really like chocolate chip cookies[SEP][Other Socials][Doctor] yeah okay well we will we will try to look check and see what's going on there okay so so what kind of so have you you've done any fun activities that now that you know it's getting warm out [Patient] yeah i went for a bike ride over the weekend and some friends have morning we we went for a bike ride and then we had a pick[SEP]
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[
"Other Socials"
] |
[
"Subjective"
] | 285
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[Acute Symptoms][Doctor] all right . good . i'm glad to hear that . great . all right . [Patient] uh , i think getting that , rid of that reflux , really helped my attitude improve .[SEP][Other Socials][Doctor] okay . okay . and you have a , a good support system at home ? i know you have a big- [Patient] yeah .[SEP][Other Socials][Doctor] . family . [Patient] yes . yes . all my kids call and check on me every day .[SEP][Chitchat][Doctor] okay . great . i'm glad to hear that . now , i know you did a review of systems sheet when you checked in . [Patient] yes .[SEP]
|
[
"Acute Symptoms",
"Vegetative History"
] |
[
"Subjective"
] | 286
|
[Personal History][Doctor] wow what happened what did they do [Patient] microdiscectomy my disk broke off and just wrapped around and connected to my spinal thecal sac[SEP][Acute Symptoms][Doctor] sounds horrible [Patient] it's not the poop sac though[SEP][Acute Symptoms][Doctor] that's good to know what kind of symptoms did you have with that [Patient] horrible pain down my leg in my back just horrible awful things that you can think of[SEP][Therapeutic History][Doctor] horrible nerve pain it sounds like [Patient] i think so[SEP][Therapeutic History][Doctor] okay did they give you any meds for that [Patient] they did i was highly highly dosed up on gabapentin[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 287
|
[Personal History][Doctor] all right . okay . um , and any history with your back in the past ? [Patient] i actually had surgery about 10 years ago on my lower back .[SEP][Personal History][Doctor] okay . all right . now , tell me a little bit about your , your heart failure . you know , i have n't seen you in a while . [Patient] mm-hmm .[SEP][Personal History][Therapeutic History][Doctor] how are you doing with your diet ? [Patient] um , been pretty good t- taking my medications , watching my diet , trying to , uh , trying to exercise regularly , too .[SEP][Vegetative History][Doctor] okay . so , you're avoiding the salty foods like we had talked about ? [Patient] yes .[SEP]
|
[
"Personal History",
"Vegetative History"
] |
[
"Subjective"
] | 288
|
[Personal History][Doctor] okay so you've had surgery before alright do you remember what kind of surgery [Patient] i do n't know they told me they reconstructed the whole thing i was fourteen i was a really good gymnast back then really good[SEP][Other Socials][Doctor] okay okay okay how so do you have any other exercises that i might wan na know about outside of intense gym and ski events [Patient] no i think that's about it[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 289
|
[Acute Symptoms][Greetings][Doctor] hey alan i good to see you today so i looked here my appointment notes and i see that you're coming in you had some shoulder pain left shoulder pain for the last three weeks so how you doing is it is it gotten any better [Patient] yeah yeah i've been having a lot of pain of my shoulder for the last three weeks now and it's not getting better[SEP][Acute Symptoms][Doctor] okay do you remember what you were doing when the pain first started [Patient] so i i was thinking that i i ca n't recall like falling on it injuring it getting hit[SEP][Acute Symptoms][Doctor] okay so do you remember hitting it or anything like that [Patient] no nothing at all[SEP][Acute Symptoms][Doctor] okay alright did you fall do you remember doing that [Patient] no[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 290
|
[Personal History][Doctor] mm-hmm okay have you ever injured that foot before [Patient] yeah no sorry i injured my other foot before not this foot[SEP][Personal History][Doctor] okay so right now you're experiencing right leg pain but you have injured your your left leg before is that what i'm hearing [Patient] yeah that's fine[SEP][Acute Symptoms][Doctor] alright were you able to continue playing [Patient] no i had to stop i actually it was like i had to be held from the field because i could n't put weight on my foot[SEP][Therapeutic History][Doctor] i'm sorry okay so what have you been doing for the pain since then [Patient] i wrapped it after a the game they had some ace wraps in their clubhouse and so i wrapped it up and then i iced it last night and i just kept it up on a pillow and then i took some ibuprofen[SEP][Acute Symptoms][Doctor] okay could you one more time when did this injury happen [Patient] this happened about couple days ago[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 291
|
[Personal History][Doctor] okay , good . and any symptoms like chest pains , shortness of breath , any swelling in your legs ? [Patient] no , not that i've noticed .[SEP][Personal History][Doctor] okay , all right . and then in terms of your depression , i know that we tried to stay off of medication in the past because you're on medications for your other problems . how are you doing ? and i know that you enrolled into therapy . is that helping ? or- [Patient] yeah , it's been helping a lot . i've been going every week , um , for the past year since my last annual exam . and that's been really helpful for me .[SEP][Personal History][Doctor] okay . so , no , no issues , no feelings of wanting to harm yourself or hurt others ? [Patient] no , nothing like that .[SEP][Personal History][Doctor] okay , all right . and then in terms of your high blood pressure , i know that you and i have kind of battled in the past with you remembering to take some of your blood pressure medications . how are you doing with that ? [Patient] i'm still forgetting to take my blood pressure medication . and i've noticed when work gets more stressful , my blood pressure goes up .[SEP][Other Socials][Doctor] okay . and , and so how has work going for you ? [Patient] it's been okay . it's been a lot of long hours , late nights . a lot of , um , you know , fiscal year end data that i've been having to pull . so , a lot of responsibility , which is good . but with the responsibility comes the stress .[SEP]
|
[
"Acute Symptoms",
"Vegetative History"
] |
[
"Subjective"
] | 292
|
[Acute Symptoms][Doctor] so less than a day . [Patient] yeah .[SEP][Acute Symptoms][Doctor] in severe pain . [Patient] yes .[SEP][Therapeutic History][Doctor] have you taken anything for the pain ? [Patient] i've been taking ibuprofen every six hours i think , but it's really not helping at all .[SEP][Acute Symptoms][Doctor] okay , what would you rate your pain ? [Patient] it's like a nine .[SEP][Acute Symptoms][Doctor] nine out of 10 ? [Patient] yeah .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 293
|
[Discussion][Medication][Doctor] okay do you think you need something stronger than meloxicam [Patient] no i'll give that a shot[SEP][Discussion][Doctor] okay any questions [Patient] when can i get back out on the field[SEP][Discussion][Doctor] well you ca n't play taggle football for a while you have to have this fracture healed [Patient] okay[SEP][Discussion][Doctor] and i would avoid doing it you know as we get older you know our bones get a little bit weaker so i would avoid the tackle football maybe flag football in the future okay [Patient] yeah yeah that sounds good[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 294
|
[Acute Symptoms][Doctor] okay do does even light pressure to it bother it like at night when you're laying in bed do the sheets bother [Patient] absolutely i was just gon na say when i'm in bed at night and those sheets come down on it or i roll over yeah that hurts a lot[SEP][Therapeutic History][Doctor] okay have you done anything to try to get it to feel better any soaks or taking any medicine [Patient] i take you know like a two ibuprofen a day and that does n't seem to help[SEP][Physical Examination][Doctor] let me see your your foot here and let me take your big toe through a range of motion if i push your top to bottom [Patient] yeah ouch[SEP][Physical Examination][Doctor] big toe joint that okay and let me move it up where as i bend it up does that hurt [Patient] it hurts but not as much as when you moved it down[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 295
|
[Personal History][Doctor] okay so i know you were sent here by your your pcp what was your understanding of why you were sent here [Patient] yeah so i actually have been someone who been struggling with headaches for years now ever since i was a teenager and they used to be around my when i would have my menstrual my menses but as i got older i noticed that it has been with that and also i can get it when i'm really stressed but recently and why i went to her is because my headaches have been getting a lot more they've just been happening a lot more frequently and a lot more severe[SEP][Personal History][Doctor] okay can you tell me a little bit about them what how do they how do they feel when they come on [Patient] so they say mostly on my right side and it even seems like it's like behind my eye and it just like this pulsing like this really bad pulsing sensation[SEP][Personal History][Doctor] okay do you notice these any activities or time of the day that makes them worse i know you said they they seem to get worse around your menstrual periods but is there any time of the day or that makes them worse [Patient] i i have noticed that you know i've been trying to exercise more in order to lose weight but i ca n't even really exercise for very long because i start of as soon as i start to jog i my headaches the headaches come back on a lot worse so i notice it when i'm exercising[SEP][Personal History][Vegetative History][Doctor] okay and do you seem to have any other symptoms when you get these headaches [Patient] i've been having a ringing in my ears for a few months now and then what really scared me is that now i'm starting to get some blurred vision it's not all the time but it it will come and go but some blurred like on the in my on the side of my vision[SEP][Personal History][Doctor] okay okay and have you experienced any numbness or tingling to your hands or feet or your face [Patient] no i have n't[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 296
|
[Physical Examination][Doctor] okay positive pain to palpation and let's bring your leg out are you having pain when with flexion or extension [Patient] a little bit no not not crazy real pain but there is definitely some pain there[SEP][Physical Examination][Doctor] okay pain with flexion and extension and how about the range of motion having full range of motion here [Patient] yeah pretty much i can get the full range just feels a little tight and will hurt[SEP][Discussion][Medication][Radiology Examination][Referral][Acute Assessment][Doctor] okay alright and for diagnostics so your x-ray so there's no fracture appreciated no bony abnormalities so that looks alright so let me tell you a little bit about my impression and plan with this so you have a knee contusion so for treatment we'll we need to rest that apply ice you know two three times a day for twenty minutes at a time take some nsaids or you know nonsteroidal anti- inflamma medication such as ibuprofen every six to eight hours as needed so i just wan na really get some rest with that if that does n't improve then we can go ahead and maybe come back in and we might do some physical therapy as well i do n't know i'm not sure i like this one all that well any do you have any questions on that [Patient] no sounds very good[SEP][Other Socials][Doctor] okay let's venture a little bit more because i need five minutes so where so where were you skiing at [Patient] so i was actually up we actually took a trip up up north and i was in the i'm in mount saint helen and washington so i was just walking in myself going out and stuff but yeah it was it was a good trip but cut a little short because of that yeah it was fun though i like going i like going to skiing so hopefully i can do some more[SEP][Chitchat][Doctor] well washington sounds nice i have n't been there but it sounds like it's pretty nice area to be in and they have a lot of maple syrup there do n't they produce a lot of maple syrup [Patient] they do they do have a lot of maple syrup and it's it's it's interesting that the the winter actually is n't their busiest time for vacation or vacations or it's more into your spring into your fall with hikers and all the outdoor activities there's actually a very impulsive torist during the summertime which i never knew but one of the locals have told me that they do actually better business during the summer so the hikers kayakers and the maple syrup in the fall and everything so[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 297
|
[Acute Symptoms][Doctor] okay and then have you experienced any numb numbness or tingling [Patient] no no numbness[SEP][Acute Symptoms][Doctor] okay alright any loss in sensation [Patient] no i mean i i can still feel like i can still feel my foot[SEP][Other Socials][Doctor] okay alright that's good to hear so you were playing tennis is that what you normally do to work out [Patient] i do i'm trying to learn but i can not afford tennis less lessons so me and my friends just hit the balls back and forth i do sleep[SEP][Chitchat][Doctor] i love it absolutely yeah my dad one time took me to play racquet ball and i learned the very bruisy way that that was n't for me yeah [Patient] that scares me[SEP][Physical Examination][Doctor] it's it they they move pretty fast i'm not gon na lie alright so if you do n't mind i'm gon na go ahead and do my my physical exam i'm gon na be calling out some of my findings but if you have any questions go ahead stop me let me know but i will be explaining along the way okay [Patient] okay[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 298
|
[Physical Examination][Doctor] alright i'm gon na press here on your back [Patient] no pain[SEP][Physical Examination][Diagnostic Testing][Acute Assessment][Doctor] okay so on your abdomen exam of your abdomen i'm showing no tenderness to palpation of the abdomen or tenderness of the the cva either on the right side so that that's good i think that's pretty much cleared up so let's we'll talk a little bit about my assessment and plan for you and so my assessment you you did have the those kidney stones but i i think they are passed this time but i do want to get a couple of labs so we'll get a urinalysis [Patient] okay[SEP][Referral][Diagnostic Testing][Doctor] alright we'll get a urine culture just to make sure everything is is cleared up i also want to give you a referral to referral referral to urology [Patient] okay[SEP][Discussion][Referral][Doctor] because you do keep having these all the time and so maybe there's something else going wrong and so they can help get that under control [Patient] can i see doctor harris[SEP][Discussion][Referral][Doctor] of course yeah we can we can get you that road to doctor harris and [Patient] he's not like[SEP]
|
[
"Medication",
"Other Treatments",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 299
|
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