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[Conversation Start][SEP][Greetings][Doctor] hi , albert . how are you ? [Patient] hey , good to see you .[SEP][Chitchat][Doctor] it's good to see you too . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you . [Patient] sure .[SEP][Personal History][Doctor] so , albert is a 62-year-old male , with a past medical history significant for depression , type 2 diabetes , and kidney transplant , who is here today for emergency room follow-up . [Patient] mm-hmm .[SEP]
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[Conversation Start][SEP][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"
] |
[
"Subjective"
] | 301
|
[Diagnostic Testing][Doctor] that will be our next step so we'll get you scheduled for the mri probably get you in pretty quick here since we're a private practice [Patient] thank god[SEP][Discussion][Other Treatments][Doctor] yeah and once you get the mri i'll know a little bit more what i'd like to do is something called a whole blood transfusion have you heard of that before [Patient] no please tell me remind me[SEP][Discussion][Other Treatments][Doctor] yeah it should help with the healing of your elbow it's just a procedure we'll stick a needle in your elbow [Patient] you do a stick needle in my elbow[SEP][Discussion][Other Treatments][Doctor] mm-hmm and help with some of the healing of your elbow [Patient] so it's kinda like dry needling then[SEP]
|
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[Conversation Start][SEP][Greetings][Doctor] hi , andrew . how are you ? [Patient] hey , good to see you .[SEP][Chitchat][Doctor] i'm doing well , i'm doing well . [Patient] good .[SEP][Chitchat][Doctor] so , i know the nurse told you about dax . i'd like to tell dax a little bit about you . [Patient] sure .[SEP][Acute Symptoms][Personal History][Doctor] uh , so , andrew is a 59-year-old male with a past medical history , significant for depression , type two diabetes , and hypertension who presents today with an upper respiratory infection . so , andrew , what's going on ? [Patient] yeah . we were doing a bit of work out in the yard in the last week or so and i started to feel really tired , was short of breath . um , we- we're not wearing masks as much at the end of the summer and i think i caught my first cold and i think it just got worse .[SEP]
|
[
"Personal History",
"Therapeutic History"
] |
[
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] | 303
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[Conversation Start][SEP][Greetings][Doctor] hi , cheryl . how are you ? [Patient] i'm doing well . how are you ?[SEP][Chitchat][Doctor] i'm doing well . so i know the nurse told you a little bit about dax . i'd like to tell dax about you . [Patient] okay .[SEP][Acute Symptoms][Personal History][Doctor] cheryl is a 34-year-old female with a past medical history significant for hypertension , who presents today with back pain . cheryl , what happened to your back ? [Patient] so i've been walking a lot lately . i've been walking to ... 30 minutes to an hour or so a day . and all of a sudden , um , when i was walking , my , um , back just kind of seized up on me . and i do n't really know what it was . maybe i was going a little bit faster . but it just all kind of clenched .[SEP][Acute Symptoms][Doctor] okay . so you felt like , maybe like a spasm or something like that ? [Patient] yeah .[SEP]
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] | 304
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[Discussion][Medication][Diagnostic Testing][Reassessment][Doctor] so i also want to go ahead and order a chest x-ray just to make sure that we are not missing anything else okay for your second problem of your coronary artery disease you know it sounds like you're doing well except for this heart failure exacerbation so i wan na go ahead and order another echocardiogram to check out that heart murmur that i hear on your physical exam just to make sure that that's not getting any worse and to make sure that the pumping function of your heart is stable and i'm gon na go ahead and call doctor white and let them know that i want you to be seen by them okay okay and then for your third problem of your stage three chronic kidney disease i want you to go ahead and try to you know do n't please do n't take anymore motrin or advil i do want you to try to stick with tylenol and if you're still having a significant problem with with some pain i want you to call me and we'll talk about some alternative medications that we can use or therapies okay i will also want to go ahead and order a complete metabolic panel just to make sure that your kidney function is stable does that sound okay [Patient] that sounds good do you have any idea what was going on with my foot pain before[SEP][Personal History][Doctor] well how long have you been having it how long you've been having that foot pain [Patient] that's why i took the motrin it lasted you know four five days slowly went away[SEP][Personal History][Doctor] it was in both of your feet [Patient] one[SEP][Personal History][Doctor] one and where in your foot was was it [Patient] just in front of the big toe[SEP][Personal History][Doctor] just in front of the big toe okay have you ever had a history of gout [Patient] nobody has told me about that[SEP]
|
[
"Discussion",
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"Diagnostic Testing",
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] |
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[Personal History][Doctor] and was it relatively a normal exam ? did you have any polyps ? [Patient] no . they said they'd see me in 10 years .[SEP][Chitchat][Doctor] well that's good news . [Patient] yeah , i agree .[SEP][Vegetative History][Doctor] um , do you have a pacemaker or defibrillator , or have sleep apnea , or use oxygen at night ? [Patient] no .[SEP][Drug History][Doctor] all right . do you ever drink alcohol ? [Patient] yeah , but only once or twice a year .[SEP][Therapeutic History][Doctor] okay . are you taking any supplements such as iron or vitamin b12 ? [Patient] i already started taking my iron pills which i have not taken in about a year .[SEP]
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"Therapeutic History"
] |
[
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] | 306
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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]
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"Discussion"
] |
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] | 307
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[Conversation Start][SEP][Greetings][Doctor] hi , andrew , how are you ? [Patient] hi . good to see you .[SEP][Chitchat][Doctor] it's good to see you as well . so i know that the nurse told you about dax . i'd like to tell dax a little bit about you . [Patient] sure .[SEP]
|
[
"Acute Symptoms",
"Personal History"
] |
[
"Subjective"
] | 308
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[Physical Examination][Doctor] okay okay good let's go ahead and do physical exam on karen here alright karen i'm just gon na take a look at you and and ask you to follow some commands okay [Patient] okay[SEP][Physical Examination][Doctor] alright can you follow my finger with your eyes good now can you do me a favor walk across the room for me great job okay now i want you to close your eyes and reach out your arms in front of you good now keep your eyes closed can you feel me touch you here how about okay how about there [Patient] mm-hmm[SEP][Physical Examination][Doctor] does that feel the same [Patient] yeah[SEP][Physical Examination][Doctor] okay alright so i'm just gon na check your reflexes okay alright now on your on the neurological exam the patient is awake alert and oriented times three speech is clear and fluent gait is steady heel toe walking is normal and the cranial nerves are intact without focal neurologic findings there is no pronator drift sensation is intact reflexes are two plus and symmetric at the biceps triceps knees and ankles so this means everything looks good karen [Patient] that's great[SEP][Discussion][Acute Assessment][Doctor] good alright so i'm gon na go ahead and tell you what we're gon na do so i'm gon na tell you my assessment and plan here so dad so for the first problem i do believe that karen does have a tick eye tics are very common in children and as many as you know one in five children have a tick during their school years and tics can also include things like shoulder shrugging facial grimacing sniffling excessive throat clearing and uncontrolled vocalization i can say that essentially they're brief sudden and involuntary motor movements now we do n't have a full understanding of the cause of the tics but they typically occur around five to ten years of age but most ticks go away on their own and they disappear within a year so these are what we call transient tics and the best thing to do is ignore the tics so it does n't seem to be bothering karen and she seems to be doing well in school and activities so it may wax and wane over time but you might notice it more towards the end of the day when the child is tired so you may also you know see it if they're stressed so that's why it's important to just ignore it now when you draw attention to the tick it does make the child conscious so that can make the tic worse so we want to be careful again just to to kind of not to draw too much attention on it and do you have any questions for me [Patient] so you mean you're telling me you do n't think he had a seizure or a bit or nothing[SEP]
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[Chitchat][Doctor] yard work [Patient] landscaping landscaping[SEP][Personal History][Other Socials][Doctor] landscaping okay so a lot of raking a lot of digging so a lot of repetitive type movements [Patient] yeah it's pretty heavy labor but it's yeah the same thing day in and day out[SEP][Acute Symptoms][Doctor] okay okay just a couple questions for you you did say that you have the pain at night in that and you have to you get that numbness into the hand is it in all the fingers [Patient] yeah it seems to happen to all my fingers but i notice it more in my thumb and pointer finger[SEP][Acute Symptoms][Doctor] okay okay and anything into that little into your fifth finger your little finger any numbness there at times no [Patient] sometimes yeah it seems like it's numb too[SEP][Personal History][Doctor] okay what about your right hand any problems with that hand [Patient] no i do n't seem to have any problems with my right hand so far it's just mostly my left[SEP]
|
[
"Drug History"
] |
[
"Subjective"
] | 310
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[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] so sophia i see that you you hurt your knee tell me about what happened [Patient] yeah i was jumping on my kid's trampoline and i could just slipped out from under me[SEP][Chitchat][Doctor] my gosh one of those big trampolines in your back yard [Patient] yeah a pretty big one[SEP]
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"Acute Symptoms"
] |
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[Discussion][Doctor] what is it [Patient] is it is that that thing where like you take the blood out of like say my my thigh[SEP][Discussion][Doctor] mm-hmm [Patient] and then you literally inject it into my tendon[SEP][Chitchat][Doctor] yeah that's exactly what it is [Patient] interesting cool[SEP]
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[
"Discussion"
] |
[
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] | 312
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[Physical Examination][Doctor] looks like you have little bit of limited range of motion on extension not on flexion though you said it hurts right here on the inside of your elbow [Patient] yes[SEP][Physical Examination][Doctor] okay so pain on the medial side with palpation [Patient] yes[SEP][Physical Examination][Doctor] alright how about the outside [Patient] no[SEP][Physical Examination][Doctor] no pain with palpation outside of the elbow you have do you have normal sensation in your fingers [Patient] i think so[SEP]
|
[
"Chitchat"
] |
[
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] | 313
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[Physical Examination][Follow-up][Doctor] all right , they look okay right now , certainly let your doctor know about this if it gets any worse or reoccurs . [Patient] okay , i will do that .[SEP][Lab Examination][Doctor] now , let's go over your lab work . so , when you took that pill , the dexamethasone test , you passed , which means you do n't have cushing's syndrome . on that test , at least . the salivary cortisol , though , unless you did one wrong ... two of them were completely normal and one was abnormal , so , we might need to repeat that in the future . [Patient] okay , that's okay .[SEP][Lab Examination][Doctor] all right , so , your cholesterol was quite high . the total cholesterol was 222 . the good cholesterol was about 44 . the bad was 153 , and it should be less than 100 . the non-hdl was about 178 , and it should be less than 130 . the good cholesterol should be over 50 , and it was 44 . so , your screen for diabetes is ... was fine . you do have a vitamin d deficiency , and , i do n't know if we started the vitamin d yet , or not . [Patient] yes , we did . i- i do need to take one today , though .[SEP][Lab Examination][Doctor] okay . so , i also checked a lot of other pituitary hormones , iron levels ... everything else seemed to be pretty good , and in decent range . [Patient] okay , that sounds great . so , i wanted to also show you my liver enzymes , um , because i have n't come back since then ... but i was also happy , because one of them was back to normal .[SEP][Lab Examination][Doctor] okay , great . let's see them . [Patient] okay . so , the one that's 30 , that was almost 200 not so long ago .[SEP]
|
[
"Personal History",
"Lab Examination"
] |
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"Objective"
] | 314
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[Vegetative History][Doctor] okay and then any numbness or tingling in in your lower extremities or any weakness there in your legs [Patient] you know it it's my back that's weak and my legs are weak both of them you know coughing sneezing seem to make it worse so sorry i'm just trying to be like a typical patient because most patients they do n't answer the darn questions so you you know all this time i still have n't gotten a chief complaint out of them so i love the way that you're trying to redirect and so you know what your doctor said you had back pain and leg pain but for me the most important thing for me to capture is that it's in the hip side of the leg side of the calf goes to the big toe and so i need them to be able to give me a perfect sort of root signature so i can hone in is that four five disk seen on the mri really significant or is it on the opposite side but again i'm sorry i'm purposely trying to be in a difficult patient because some of these patients he asked them fifty different questions they wo n't answer any of them so anyway sorry about well[SEP][Chitchat][Doctor] that's okay [Patient] to explain but this is what i deal with every single day[SEP][Vegetative History][Doctor] absolutely [Patient] lot of pain yeah you know what my pain is eight out of ten it goes in the back goes into the hip side of the leg side of the calf goes to the big toe my foot kinda drags when i walk i've been having to use a cane nothing seems to make it better and but very few patients will give you the perfect history and most people will start talking about you know when something happened or go back to thirty years ago and you wan na redirect them to their current symptom but the patients wo n't rarely ever tell you what the chief complaint is you you got ta pull it out of them[SEP][Physical Examination][Doctor] so let's take a a quick look at you here okay let's do a physical exam real quick so your vitals look good which is a good thing now on your back exam i do n't see any bony abnormalities no redness or no and no bruising present now do you have pain when i press here [Patient] no it's right here[SEP][Physical Examination][Doctor] okay so positive for pain to palpation at the l4 vertebrae and if you bend forward do you have pain there [Patient] it hurts all the time especially sitting in these run office desks[SEP]
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] | 315
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[Conversation Start][SEP][Greetings][Doctor] hi miss russell . [Patient] hi-[SEP][Greetings][Doctor] nice to meet you- [Patient] doctor gutierrez . how are you ?[SEP][Greetings][Doctor] i'm well . [Patient] good .[SEP][Acute Symptoms][Doctor] hey dragon . i'm seeing miss russell . she's a 39-year-old female here for , what are you here for ? [Patient] it's my right upper arm . it hurts really , really bad .[SEP]
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] | 316
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[Personal History][Doctor] do n't weigh all so speaking of eating let's talk a little bit about your diet i see here on your chart that you're a type two diabetic and it looked like that you were gon na handle that with diet and exercise let's talk about that a little bit [Patient] well you know i my my diet was worse when i before i was diagnosed with the the type two diabetes[SEP][Personal History][Other Socials][Doctor] okay so other than the weight loss how how is your diet is that has that been working out for you i mean do you does does that does that fit your lifestyle pretty well [Patient] yeah it does it does it it i was surprised it was n't as hard as i thought to go back and cut back and go more of a keto diet[SEP]
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] |
[
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] | 317
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[Acute Symptoms][Personal History][Greetings][Doctor] patient shirley taylor . date of birth 5/4/1961 . mrn 0000123 . patient is a 60 year old right-handed female new patient referred by dr. jacob ward for evaluation of bilateral hand numbness and tingling . please note that i personally reviewed the ct brain with and without contrasting did 2/5/21 . uh , no metastatic disease . no acute intercranial abnormalities . hello ms. taylor . how are you doing this morning ? [Patient] hi dr . lopez . this weekend was a bit rough . i've had this numbness and tingling for a few weeks now .[SEP][Personal History][Doctor] so , in both of your hands ? [Patient] yeah . ever since my car wreck last december when i broke them . well , once they heal , i mean , i noticed it more , the , the tingling and numbness .[SEP][Personal History][Doctor] are you still wearing the splint only on your right wrist ? [Patient] no . i wear the left one also sometimes . the right one's just worse . the splint seems to help . both have gotten worse over the last month . when i broke them though , my wrist was definitely in worse shape than it is today . i've been having some mild stiffness in my neck too . i hit my head during the accident , and they told me it was a contusion .[SEP][Acute Symptoms][Doctor] okay . and where exactly on the right side would you say the tingling and numbness is ? [Patient] on the right , i can really notice it from my middle and ring finger all the way up to my forearm , and on my left , a bit more the pinky and the ring and not the middle .[SEP][Acute Symptoms][Doctor] all right . and , um , is there is pain or , or just tingling and numbness ? [Patient] uh , mainly just sore . sometimes they throb , but overall , they feel weaker too , especially when i'm using them . the tingling happens some more , but when they hurt , you know , it goes away and then the tingling's just dull .[SEP]
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[Acute Symptoms][Doctor] okay which knee was it [Patient] my right knee[SEP][Acute Symptoms][Doctor] right knee okay and when did this happen [Patient] about four days ago[SEP][Acute Symptoms][Doctor] great the weather was perfect this weekend so i'm glad you at least got outside sorry to hear you got hurt okay so your right knee did you did you feel it like pop or or snap or anything when you hurt it [Patient] yeah i felt a little pop and then it swelled up really big afterward[SEP][Acute Symptoms][Therapeutic History][Doctor] okay did you try anything for the pain [Patient] i took some ibuprofen and i put some ice on it[SEP][Acute Symptoms][Therapeutic History][Doctor] okay did that help [Patient] a little bit but it's still really hard to get around[SEP]
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[Discussion][Other Treatments][Doctor] i understand . um , you can close your gown now . the only thing that is really going to help out that is to uh , to cut it out and re-close it . [Patient] okay[SEP][Discussion][Other Treatments][Doctor] and you do n't want that , ? [Patient] i mean , not right now .[SEP][Discussion][Follow-up][Doctor] um , you want to come back and revisit um , maybe six months ? [Patient] yeah , i will do that . i still have n't , i still have some more of the gel and i can try using that again .[SEP][Discussion][Medication][Doctor] okay . keep doing that twice a day . the gel is going to lighten the color a little bit , which is already pretty light . um , but , just in that area , and it's high tension , so it's going to rub a little bit . [Patient] yeah , but it kind of bothers me a little bit .[SEP][Discussion][Other Treatments][Doctor] uh , i do see that . like i said , the only way to really fix that is to cut it out . [Patient] uh- .[SEP]
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[Vegetative History][Doctor] was the pain worse with eating or exercise ? [Patient] yes . with eating .[SEP][Vegetative History][Doctor] okay . any difficulty swallowing ? [Patient] mm-hmm . i did .[SEP][Personal History][Vegetative History][Doctor] okay . and that's also resolved since the initial episode three months ago ? [Patient] yes . thankfully . the chest pain and swallowing problem got better about three days after i went to the er . but i just feel like there's something wrong .[SEP][Vegetative History][Doctor] okay . so how has your weight been . [Patient] i've been trying to lose weight .[SEP][Vegetative History][Doctor] that's good . any in- ... issues with abdominal pain ? [Patient] uh , no .[SEP]
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"Vegetative History"
] |
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[Conversation Start][SEP][Greetings][Acute Symptoms][Doctor] hi kenneth how are you the medical assistant told me that you had some knee pain [Patient] yeah i was getting ready for the holiday weekend and i was out on my boat skiing and i i did a jump and kinda twisted when i landed and my knee has been hurting me ever since[SEP][Acute Symptoms][Doctor] okay so that was about five days ago then [Patient] yeah yeah that was last weekend[SEP][Acute Symptoms][Doctor] last weekend okay now which knee is it [Patient] it's my right knee[SEP]
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] |
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] | 322
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[Vegetative History][Doctor] okay and then you said you do n't vape so no vaping or e-cigarette use at all [Patient] hmmm hmmm[SEP][Other Socials][Drug History][Doctor] okay and then are you routinely in an area where there is a lot of airborne particular like smoking in bars or around any type of of you know like race tracks or anything like that [Patient] sometimes i go to the bars with some friends and yeah the smoking does irritate me[SEP][Physical Examination][Doctor] okay thank you for sharing that with me so if it's okay with you i'd like to go ahead and do a quick physical exam [Patient] okay[SEP][Physical Examination][Follow-up][Medication][Acute Assessment][Doctor] now i reviewed your vitals for today and your your blood pressure is good it's one twenty eight over eighty two your respiratory rate is sixteen and your oxygen saturation is ninety nine percent on room air which is a good thing i'm gon na take a listen to your heart here your heart is regular rate and rhythm and i do n't appreciate any ectopic beats or and i do n't hear anything like rubs murmurs or gallops which is good so i'm gon na go take and listen to your lungs here on your lung exam i do appreciate some diminished lung sounds throughout with the occasional slight expiratory wheeze and that's bilaterally so i hear that on both sides i'm gon na go do a quick neck exam here neck is supple trachea is midline i do n't appreciate any lymphadenopathy taking a listen here i do n't appreciate any carotid bruit now i'm also gon na take a look at your hands here i note strong bilateral pulses i do n't appreciate any clubbing on any of your fingertips which is which is important and i also note brisk capillary refill i'm gon na go ahead and review the results of your pulmonary function test that i had you do when you came into the office today and reviewing those results i do see that they are consistent with somebody who would be diagnosed with asthma so lem me go ahead and tell you a little bit about my assessment and plan so now for your first problem of asthma your symptoms are consistent with moderate to intermediate or i'm sorry moderate moderate intermittent asthma and it's gon na be really important for us to be consistent with your inhaled inhaled steroid inhaler so i'm gon na need you to take that as prescribed and that's really gon na help cut down on those daily symptoms and needing to use that rescue inhaler that albuterol inhaler as frequently so the more you take and more consistently you take your inhaled steroid inhaler the less you will use your albuterol now it's not a fast acting inhaler like your albuterol but what is important is as going to be what helps you long term now if you do have an acute exacerbation so if you're having an acute issue with your breathing i do want you to continue to use your albuterol inhaler one to two puffs and then i want you to wait and see how your breathing is before you would take an additional one to two puffs we hope you have less of those acute exacerbations as you continue to use your inhaled steroid i'm also going to put together an asthma action plan for you and that's gon na help us look at your symptoms see where your your pain points can be you know like those being having issues with with cats or dust that type of thing and we'll work on how to handle those symptoms through that asthma action plan so do you have any questions comments or concerns otherwise i will see you in thirty days [Patient] alright thank you[SEP]
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[
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[Vegetative History][Doctor] not really ? [Patient] . well , i have n't had any pasta ; i just do n't really like it , so we do n't have any in the house . we do n't often have bread , and if we do , we buy wheat bread .[SEP][Vegetative History][Doctor] okay . but even the wheat bread , try to cut down on the number of slices you eat per day . [Patient] i just usually have two in the morning . i do n't care for sandwiches much ; maybe peanut butter sandwiches once in a while .[SEP][Vegetative History][Doctor] well , that's great . [Patient] i drink club soda .[SEP]
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[
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] | 324
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[Acute Symptoms][Doctor] okay and do you remember what you were doing when the pain started [Patient] honestly i've been trying to recall if i had any specific injury and i ca n't think of that[SEP][Personal History][Doctor] okay alright tell me have you ever had pain in that shoulder before [Patient] you know i i'm really active and so i i will get some aches and pains here and there but nothing that tylenol ca n't take care of[SEP][Acute Symptoms][Doctor] okay good but now are you able to move your arm [Patient] you know i have trouble when i'm trying to reach for something or lift any objects and i do n't even try to reach it for anything over my head because then it'll really hurt[SEP][Acute Symptoms][Doctor] okay alright and and now are you having the pain all the time or does it come and go [Patient] the pain is always there and then it gets worse like if i try to put any pressure on it it gets worse so if i'm laying at night if i try to even lay on that shoulder it's unbearable[SEP]
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[
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"Therapeutic History"
] |
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] | 325
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[Vegetative History][Doctor] but i wan na go ahead and , um ... you know , i know that the nurse did a review of system sheet and we just covered a lot here . [Patient] mm-hmm .[SEP][Vegetative History][Doctor] any other symptoms , abdominal pain , nausea , vomiting ? [Patient] no , no .[SEP][Vegetative History][Doctor] no , just the knee pain ? [Patient] mm-hmm .[SEP][Physical Examination][Doctor] okay . all right . well , let's go ahead and do a quick physical exam . [Patient] okay .[SEP][Physical Examination][Doctor] hey , dragon , show me the vital signs . so your vital signs here in the office look really good . [Patient] mm-hmm .[SEP]
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[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][Doctor] okay and if i come over here to the right no [Patient] not that much you know[SEP][Physical Examination][Doctor] okay so and then on the left hand side if i push down here kind of into your butt [Patient] yeah[SEP][Chitchat][Doctor] yeah okay [Patient] yeah[SEP]
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[Chitchat][Doctor] interrupt you [Patient] yeah[SEP][Personal History][Therapeutic History][Doctor] okay have you tried taking melatonin to sleep [Patient] i used it a couple times but but it did n't seem to help that much[SEP][Discussion][Medication][Doctor] okay how about i do n't think i've prescribed you anything yet do you think you would need anything [Patient] hmmm i do n't really wan na take any sleeping pills[SEP][Medication][Reassessment][Doctor] okay that's understandable alright so for the last issue for the insomnia i'm just gon na have you take ten milligrams of melatonin as needed [Patient] okay[SEP][Discussion][Doctor] and just try i guess the best as possible to practice the proper sleep hygiene so you can get to sleep at night and and feel pretty rested [Patient] okay[SEP]
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[Chitchat][Doctor] was that long ago [Patient] yes[SEP][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]
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] |
[
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] | 329
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[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][Physical Examination][Doctor] all right . do you have any tenderness ? [Patient] no , not really .[SEP][Discussion][Acute Assessment][Medication][Doctor] okay . so the abdomen is soft , non-tender . no masses or organomegaly . and let me take a listen . normal active bowel sounds . all right . you can go ahead and sit up now . thank you . all right , so first i want you to try citrucel . it does come in a tablet . you should use it twice daily for regularity . then i would say , if you know you're going out and will possibly have diarrhea as a result , you can go ahead and use your bentyl 20 milligrams . you can do one tablet before you eat , and then repeat up to four times daily . and then on days when you feel good , you do n't have to use anything . um , and then on friday before you leave the house , you can take a bentyl and put one in your pocket for later , and then you can repeat the same thing on saturday if you want , and that will be totally fine . [Patient] okay , that sounds good .[SEP]
|
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] | 330
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[Personal History][Doctor] okay alright and so okay fair enough now how's your diabetes been been been doing lately have you what have your blood sugars been running in the low one hundreds or two hundreds or what [Patient] i have n't been checking my blood sugars[SEP][Therapeutic History][Doctor] really okay well we will get you back on that and and we can talk about that but how about your metformin are you still taking the five hundred milligrams once a day no actually it looks like we increased your metformin to five hundred milligrams twice a day last visit are you still taking that [Patient] yes[SEP][Personal History][Doctor] okay great and okay you're still watching your diet and getting some exercise [Patient] i have not been eating well because i've been stressed over the last week but i have n't been exercising for maybe the past week but generally i've been doing better[SEP][Personal History][Doctor] okay the headache has has maybe made you feel uncomfortable and prevented your your exercise would you say or what [Patient] yes it has[SEP][Other Socials][Doctor] okay okay so you probably have n't been out golfing i remember you're a big golfer so not not lately uh so you know being [Patient] not lately[SEP]
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] |
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] | 331
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[Discussion][Other Treatments][Doctor] yeah that sounds like a great idea and i think if that's something that we can maybe discuss to get you in contact with someone who can offer you someone with a degree that can offer you some really good advice you know i do n't wan na as much as it's really helpful to have friends i do wan na be able to give you like a source of truth right [Patient] yeah i i had a diabetic consult a long time ago but yeah it it would be nice to see a dietitian again and go over those and maybe there is some new stuff too[SEP][Discussion][Physical Examination][Other Treatments][Doctor] a hundred percent yeah you know like i one of the things that i struggle with is like are eggs good for you or bad for you you know like with cholesterol i feel like it changes every other year or something like that so you're right there may be some pieces of information that we do need to update and and you know over a fresh of course would n't hurt but if you do n't mind i'm gon na go ahead and start my physical exam i'm gon na call out my findings and just go let me know if you have any questions or if anything sounds anything that you you want me to expand on further but this is just for the recording sake so we can get everything documented okay [Patient] yeah and can i ask you what word what were my vital signs can you show me what my vital signs were[SEP][Physical Examination][Doctor] yeah that's uh uh that's a really good question so our big and favorite one is gon na be your blood pressure right so you're right like we are seeing some some definite improvement today it was one twenty over seventy and honestly that's a great place to be so that tells me that your medication is working and that maybe we can start to evaluate a bit more your respiratory rate is completely normal so i see it here as eighteen that's wonderful you are not running a fever so ninety seven . nine and you're honestly that's within like a good enough range for me you're satting pretty well your oxygen saturation is a hundred percent again so that means that you're not experiencing any kind of difficulty getting in that oxygen to the rest of your body i do wan na say that you know pain is one of the vitals that we worry about and you're saying that at it's worst your the pain in your elbow is a seven out of ten so that's something that i'm gon na evaluate and then your pulse rate seems to be appropriate as well so those are all great do you have any questions about that so far [Patient] no that sounds good yeah i was just curious[SEP][Physical Examination][Other Socials][Doctor] mm-hmm i do wan na say that like looking at your the weight we do see like maybe a five pound increase from the last time that you were here but that's completely normal right to be able like to fluctuate you know give or take five pounds so i'm not i'm not i'm not like seriously worried about it but if we do come back and notice an additional five pounds then we might have to start talking about like actually you know what let's do that right now what kind of exercise regimen are you on [Patient] well i do go for some walks in the evening i try to get one in on the morning too[SEP]
|
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|
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] hi billy how are you doing the medical assistant told me that you have a cough today [Patient] yep i'm doing pretty good you know cough started about a week ago or so you know i just started bringing up some yellow stuff and not feeling the greatest the last two days though[SEP]
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[Acute Symptoms][Therapeutic History][Doctor] yes . what do you do for your acne in the morning ? and then what do you do at nighttime ? [Patient] i wash my face , more like i wipe it down in the morning . then at night i use an elf facial cleanser called the super clarity cleanser . i finish with a toner and then the persa-gel .[SEP][Therapeutic History][Doctor] when you say , " wipe your face in the morning , " do you use a product or just water ? [Patient] mm , just water and a washcloth , really . if i feel really greasy , sometimes i'll use the elf cleanser in the morning , too .[SEP][Acute Symptoms][Doctor] okay . and is today a good day , bad day , or an average day for you ? [Patient] mm , i would say it's probably a good day for me , of course , since i'm here , right ?[SEP][Acute Symptoms][Vegetative History][Doctor] acne is always good when you come to see the doctor . do you find that your acne flares with your periods ? [Patient] no , not really .[SEP][Vegetative History][Doctor] and do you get a regular period ? [Patient] yup .[SEP]
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] |
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] | 334
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[Vegetative History][Doctor] alright now have you had any fevers [Patient] not that i remember i i feel warm but never really took my temperature[SEP][Vegetative History][Doctor] you feel warm okay alright any chills [Patient] no no chills you know just a little achy at times[SEP][Vegetative History][Doctor] okay and how about any shortness of breath do you ever feel short short of breath at all [Patient] no no i have no shortness of breath[SEP][Vegetative History][Doctor] no shortness of breath okay and how about any runny nose sore throat sinus pain or pressure [Patient] yeah i get a like congested you know kinda drainage down my throat and you know a little bit of pressure in my sinuses[SEP][Other Socials][Doctor] okay and anyone else sick in your household [Patient] no unfortunately just need[SEP]
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[Physical Examination][Doctor] all right . well , for physical exam , please use the regular template . all right , please just breathe normally . great . and now take a few deep breaths for me . all right . do you feel okay ? are you feeling any dizziness or anything ? [Patient] no , i feel fine .[SEP][Physical Examination][Doctor] okay , great . all right . well , that is it for the exam . [Patient] okay .[SEP][Diagnostic Testing][Doctor] all right . so what i'm thinking is , let's go ahead and schedule you for an echocardiogram . it's a very common test and it just takes a picture of your heart . and it'll let me see how well your heart is actually working . [Patient] okay .[SEP][Discussion][Diagnostic Testing][Doctor] and i can order that for today . um , do you have time to complete that ? it should n't take too long . [Patient] yes , that's fine . i have time .[SEP][Discussion][Diagnostic Testing][Doctor] okay , great . so we will complete that today , um , to assess your overall cardiac structure and function , as well as , uh , the valve view of where diseased . [Patient] okay .[SEP]
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] | 336
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[Chitchat][Doctor] okay . let me put that into the system , and then downstairs they can do the ultrasound . [Patient Guest] all right , thank you .[SEP][Other Socials][Doctor] okay , yeah . where do you all live ? [Patient Guest] uh , we live in dallas .[SEP][Family History][Doctor] okay . anybody in the family with kidney failure , dialysis or transplant ? [Patient Guest] no .[SEP][Diagnostic Testing][Doctor] okay . so let's get your ultrasound done , and we'll see how it goes . [Patient Guest] all right , that sounds good .[SEP][Physical Examination][Doctor] all right . let me take a quick look at her . [Patient Guest] sure .[SEP]
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] |
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] | 337
|
[Personal History][Vegetative History][Doctor] okay , all right . okay , and- and can you describe it ? [Patient] it's like a burn .[SEP][Personal History][Vegetative History][Doctor] okay , and where exactly is it located in your chest ? [Patient] just , um , right in the middle ...[SEP][Personal History][Vegetative History][Doctor] okay . and how often are you getting it ? [Patient] um , probably about three- three times a week .[SEP]
|
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"Vegetative History"
] |
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] | 338
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[Personal History][Vegetative History][Doctor] okay , and where exactly is it located in your chest ? [Patient] just , um , right in the middle ...[SEP][Personal History][Vegetative History][Doctor] okay . and how often are you getting it ? [Patient] um , probably about three- three times a week .[SEP][Acute Symptoms][Vegetative History][Doctor] okay , all right . well i'm glad that you talked about that with me today , um , i know the nurse did a review of systems sheet with you , and , you know , you're obviously endorsing this- this chest pressure . um , have you had any other symptoms , i know the- the other ones that you have n't had , but any lower extremity edema , or muscle aches , or fever chills ? [Patient] no , nothing like that , but i have had a little bit of congestion , um , just from allergies , because of the pollen .[SEP][Vegetative History][Doctor] okay , so you're endorsing some nasal congestion ? [Patient] yeah .[SEP]
|
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] |
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] | 339
|
[Acute Symptoms][Therapeutic History][Doctor] okay , all right . i think they have here metformin ? [Patient] yeah , that's- that sounds right .[SEP][Acute Symptoms][Personal History][Doctor] all right , um , and , um , in terms of your anxiety , i'm sure that this did n't help much- [Patient] did n't help , no , not at all .[SEP][Personal History][Doctor] how are you doing with that ? [Patient] um , i had my moments but , um , it ... now that it's almost the weekend , it's- it's been a little bit better . i think things are under control by now . um , i had my moments but , um , it ... now that it's almost the weekend , it's- it's been a little bit better . i think things are under control by now .[SEP][Acute Symptoms][Personal History][Doctor] okay ? um , how about your epilepsy , any seizures recently ? [Patient] not in a while , it's been actually quite a few months and it was something minor but noth- nothing major ever since .[SEP][Chitchat][Doctor] okay . all right , well you know i wanted to just go ahead and do , um , a quick review of the systems , i know you did a cheat with the nurse- [Patient] mm-hmm .[SEP]
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[
"Vegetative History"
] |
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] | 340
|
[Physical Examination][Doctor] okay , squeeze my finger here . good . can you feel me touch out here ? [Patient] yep .[SEP][Physical Examination][Doctor] okay . and , can you feel me touch you down here ? [Patient] yep .[SEP][Physical Examination][Doctor] okay . no swelling . push your leg out . good . pull it back . mm-hmm . go . good . okay . so , on my exam , um , essentially , your exam is normal . your , um , heart is regular . you do have that grade 2 , um , systolic ejection fraction back ejection murmur that you , um , that we've heard in the past . okay ? so , um , we definitely know that's there . that's unchanged , okay ? um , your lungs are clear . um , your grips are equal . neurovascular's intact . you do n't have any carotid bruits in your neck , no thyromegaly . no edema . um , pulses are good , so essentially , your exam is , is essentially normal . let's take a look at some of your lab work , okay ? [Patient] okay .[SEP][Therapeutic History][Lab Examination][Doctor] hey , dragon , show me the hemoglobin a1c . okay , so , blood sugars have been elevated . your hemoglobin a1c is elevated as well , so that tells me your blood sugars have been a little bit out of control . you're still taking the metformin , correct ? [Patient] yes , i am .[SEP][Therapeutic History][Doctor] okay , and you take that twice a day ? [Patient] yep .[SEP]
|
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] |
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] | 341
|
[Physical Examination][Doctor] all right . does that hurt ? [Patient] a little bit . that's tender .[SEP][Physical Examination][Doctor] okay , so on physical examination , on your heart exam , i do appreciate a little two out of six systolic ejection murmur- [Patient] mm-hmm .[SEP][Physical Examination][Doctor] . which we've heard in the past . okay , so that seems stable . on your knee exam , there is some edema and some erythema of your right knee , but your left knee looks fine , okay ? um , you do have some pain to palpation of the right knee and some decreased range of motion , um , on exam , okay ? so what does that mean ? so we'll go ahead and we'll see if we can take a look at some of these things . i know that they did an x-ray before you came in , okay ? [Patient] mm-hmm .[SEP][Radiology Examination][Doctor] so let's take a look at that . [Patient] sure .[SEP][Radiology Examination][Doctor] hey , dragon , show me the right knee x-ray . so here's the r- here's your right knee x-ray . this basically shows that there's good bony alignment . there's no acute fracture , which is not surprising , based on the history . [Patient] mm-hmm .[SEP]
|
[
"Lab Examination"
] |
[
"Objective"
] | 342
|
[Discussion][Doctor] yeah , use , um , right hand- [Patient] okay .[SEP][Discussion][Doctor] . instead- [Patient] mm-hmm .[SEP][Discussion][Doctor] . for the next , uh , at least just three to four weeks . [Patient] mm-hmm .[SEP][Follow-up][Doctor] uh , come back to see me if the pain , you know , still there after maybe three weeks- [Patient] sure .[SEP][Follow-up][Doctor] . so we can take a further look . [Patient] okay . sure .[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 343
|
[Drug History][Drug History][Doctor] okay alright when did you stop smoking [Patient] couple years ago maybe four or so years ago[SEP][Drug History][Doctor] okay alright and how many packs a day would you smoke [Patient] gosh back then yeah was at least two[SEP][Drug History][Doctor] okay alright how many years did you smoke for like twenty [Patient] yeah at least twenty yeah twenty plus years[SEP][Acute Symptoms][Doctor] okay alright now any other symptoms do you have any problems when you walk down the street do you get any pain in your calves at all when you walk [Patient] no no no no pain you know just kind of you know it's just i know that it's there[SEP][Acute Symptoms][Doctor] okay and you said you're active you're out in the yard and things like that do you go on long walks at all or no [Patient] no no you know it's you know i just kinda feel like i've been just trying to take it easy lately[SEP]
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] |
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] | 344
|
[Acute Symptoms][Doctor] yeah , okay . [Patient] and , uh , i do n't know . maybe i must have toppled over into some weird position , so it started to pain since then , uh , because of a certain move .[SEP][Acute Symptoms][Doctor] okay , uh- [Patient] i went overboard , i think . yeah .[SEP][Physical Examination][Doctor] all right , lem me , uh , take a quick look . uh , can you move up a little bit ? yeah . [Patient] uh , yeah . in fact , that's hurts .[SEP][Physical Examination][Doctor] does that- does it hurt ? [Patient] yeah , it does .[SEP][Physical Examination][Doctor] what if you move back a little bit ? [Patient] uh , that also hurts , doctor .[SEP]
|
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] |
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] | 345
|
[Personal History][Doctor] perfect . i want to back up and go over your history so i can make sure everything in your chart is correct and i do n't miss anything . so , i'll tell you what we have in your chart from your other providers and you tell me if anything is wrong or missing . sound good ? [Patient] sounds good .[SEP][Personal History][Doctor] great . so , i have that you were found to have a calcification in your right breast during a mammogram in october 2019 . was that just a normal screening mammogram , or was it done because you felt a lump ? [Patient] it was just a normal one you're supposed to get every so often .[SEP][Personal History][Radiology Examination][Doctor] i see . and then it looks like you had an ultrasound of your right breast on november 3rd , 2019 , which revealed a mass at the two o'clock position , 11 centimeters from the nipple in the retroareolar region . the report states the mass was point four by two by three centimeters . [Patient] yes , that sounds right . hard to remember now , though .[SEP][Personal History][Radiology Examination][Doctor] yep , definitely . based on those results , they decided to do an ultrasound-guided core needle biopsy on december 5th , 2019 . pathology results during that biopsy came back as grade two , er positive , pr positive , dcis , or ductal carcinoma in situ . [Patient] yes . unfortunately .[SEP][Personal History][Doctor] i know . scary stuff . but you had a lumpectomy on january 20th , 2020 , which removed the eight millimeter tumor and margins were negative . the pathology confirmed dcis . looks like they also removed 5 lymph nodes , which , thankfully , were negative for malignancy . that's great ! [Patient] yeah , i was definitely very relieved .[SEP]
|
[
"Personal History"
] |
[
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] | 346
|
[Greetings][Doctor] hi russell how are you what's been going on [Patient] well i've been having this sharp pain on the right side of my abdomen below my ribs for the last several days i saw my doctor and they ordered a cat scan and said i had a kidney stone and sent me to see a urologist[SEP][Acute Symptoms][Doctor] okay well does the pain move or or or go anywhere or does it stay right in that same spot [Patient] yeah it feels like it goes to my lower abdomen in into my groin[SEP][Acute Symptoms][Doctor] okay and is the pain constant or does it come and go [Patient] it comes and goes when it comes it's it's pretty it's pretty bad i feel like i ca n't find a comfortable position[SEP][Acute Symptoms][Vegetative History][Doctor] okay and do you notice any any pain when you urinate or when you pee [Patient] yeah it kinda burns a little bit[SEP][Acute Symptoms][Vegetative History][Doctor] okay do you notice any blood [Patient] i do n't think there is any you know frank blood but the urine looks a little dark sometimes[SEP]
|
[
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] |
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"Subjective"
] | 347
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[Other Socials][Vegetative History][Doctor] well so do you do you go out to eat a lot or do you where you where where are you eating those potato chips or is that just the home snacking or [Patient] that's home snacking i buy the the the the brand name salt and vinitive because brand wo n't taste real good but the the brand names really tastes good[SEP][Other Treatments][Vegetative History][Doctor] goodness well you know you we need to probably stop eating those now [Patient] yeah well i hate to hate to give those up but i guess i might have to[SEP][Acute Symptoms][Doctor] well since you've been in the hospital and and they've helped you out with some with all that how are you feeling now [Patient] well i'm i'm doing better[SEP]
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[Physical Examination][Doctor] alright so wrist abduction adduction positive for pain on movement are you able to make a fist [Patient] hmmm yeah a little bit but i ca n't do it really tight[SEP][Physical Examination][Doctor] okay alright okay so i'm just gon na go ahead and feel on your fingers really quickly alright metacarpals intact noticed some obvious swelling ecchymosis obvious swelling and bruising tenderness on palpation throughout there is evidence of potential fracture feeling some bony crepitus alright so this pain is it like chronic i wanted to ask you [Patient] yeah i would say it kinda goes away when i take that ibuprofen but for the most part i feel it i feel it there and it it's just really really bad when i move it all[SEP][Physical Examination][Doctor] okay so when you like is there a position either hurts less or hurts more like say if your arm is raised and elevated over your head does it hurt more or is it just best to keep it like down [Patient] it's good if i keep it a little bit above my like a little i guess a little bit like around my like just a regular level like if you're typing or something and then i just put it on a pillow and i just let it stay straight like i feel better[SEP][Physical Examination][Other Treatments][Radiology Examination][Acute Assessment][Doctor] okay yeah no i do n't think i understand completely okay so i took a look at your vitals and your blood pressure is a little elevated but honestly that's probably to do with the pain right our body can respond to pain in that way we are looking at like a hundred and forty over over seventy it's not anything crazy but something to mention i see that your heart rate is also a little elevated at like about like eighty beats a minute you are not running a fever so that's great look at ninety ninety seven . two your respiratory rate is pretty normal at like twenty so before we came in i i know that we had you do an x-ray and i'm sure that that was a bit more painful because we had to do so many manipulations but i do wan na note that you are positive for what we call a colles' fracture what that means is that the joints between your wrist like the bones between your wrist that there there is evidence of a a fracture and we are gon na have to treat it a little conservatively at first and then consider some of the options options that are available to us so for your primary diagnosis of a colles' fracture we are going to give you a thumb spica for today and that's going to [Patient] i'm sorry[SEP][Chitchat][Doctor] pardon what [Patient] a what[SEP]
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] |
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] | 349
|
[Personal History][Doctor] okay , good . so , um ... i know my nurse did a review of systems before you came in . there were really no significant issues . you have a history of chronic back pain , that's been doing well ? [Patient] yeah , it comes and goes , but right now it's been doing really well .[SEP][Personal History][Doctor] okay , no pain going down your legs or anything like that ? [Patient] no .[SEP][Personal History][Therapeutic History][Doctor] okay . and i know you have some depression , you've been on medication . how's that been going ? [Patient] that's been going really well .[SEP][Vegetative History][Doctor] sleeping well ? [Patient] yeah .[SEP]
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] |
[
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] | 350
|
[Acute Symptoms][Therapeutic History][Doctor] okay and i may miss did you say what have you been taking for pain for that [Patient] i just been taking some advil and then icing as much as i can so that's about it[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and does that seem to help or [Patient] a little bit yeah a little bit i mean it's it's still like you know sore to touch but it definitely dulls it a little bit[SEP][Other Socials][Doctor] well sounds like you have quite a few projects going on what all what all are you doing for for your yard and [Patient] i well let's see i've been putting an outdoor shower in we're extending our patio putting making some flower boxes putting down some you know for stone and all the flower beds so my wife's really put me to work i got a laundry lift[SEP][Other Socials][Doctor] wow it sounds like a variety of projects but if you're putting down stone you're probably lifting those as well and then [Patient] yeah[SEP]
|
[
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] |
[
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] | 351
|
[Conversation Start][SEP][Greetings][Doctor] hi , albert . how are you ? [Patient] hey , good to see you .[SEP]
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"Chitchat"
] |
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] | 352
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[Personal History][Doctor] okay , and what shoulder was that ? [Patient] that was my right shoulder .[SEP][Vegetative History][Doctor] okay , all right . and , um , any pins and needles in your feet at all ? any swelling in your legs ? [Patient] uh , no , nothing like that .[SEP][Personal History][Doctor] okay , and your blood sugars have been under control ? [Patient] yes , they have been .[SEP][Vegetative History][Doctor] okay . and have you had any fever or chills ? [Patient] no , nothing like that .[SEP]
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[
"Vegetative History"
] |
[
"Subjective"
] | 353
|
[Acute Symptoms][Doctor] okay . any pain shooting down your legs at all ? [Patient] no .[SEP][Acute Symptoms][Doctor] is it on one side or the other of your back ? [Patient] um , it's more on the right .[SEP][Acute Symptoms][Doctor] on the right . is there anything that makes it better or worse ? [Patient] uh , if i'm lying flat it hurts a little more , and any twisting motion for sure .[SEP][Personal History][Doctor] okay . all right . and do you have any history or any back problems before ? [Patient] i did . i had a fusion done .[SEP]
|
[
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] |
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] | 354
|
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] so hi zachary good to see you today so i'm looking at my notes i see you coming in with some right elbow pain and you also have a past medical history of hypertension diabetes we're gon na check on those so can you tell me what happened to your elbow [Patient] i just woke up one day it was hurting[SEP]
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[
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] |
[
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] | 355
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[Physical Examination][Doctor] little bit how about when i press on the outs the outside gon na press on the outside is that painful [Patient] no[SEP][Physical Examination][Doctor] no alright so i'm gon na have you flex your knee is that painful [Patient] yeah that's uncomfortable[SEP][Physical Examination][Doctor] that's uncomfortable and extend it so that's painful [Patient] yeah yes[SEP][Physical Examination][Medication][Other Treatments][Radiology Examination][Reassessment][Acute Assessment][Doctor] okay so on your knee exam i i see that you do have pain to palpation of the medial aspect of your right knee you have some pain with flexion extension i also identify some edema around the knee and some effusion you have a little bit of fluid in there as well so prior to coming in we did do an x-ray of that right knee and luckily you did n't break anything so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you have what we call a mcl strain so a medial collateral ligament strain so when you fell i think you twisted a little bit and so it irritated you strained that that ligament there so for that what we can do for you first i'm gon na prescribe you some ibuprofen eight hundred milligrams and you can take that twice a day and that's gon na help you with that swelling and that pain that you currently do have i'm also gon na put you in a a knee brace just to try and support those muscles to allow it to heal and then i want you to ice the knee you can do that for twenty minutes at a time for three to four times a day that should also help with the the swelling of your knee for your hypertension now i'm gon na keep you on that twenty of lisinopril okay because you are taking it and you you're doing pretty good with it i also want to get you a referral to nutrition just to try to help you with that diet you know because right now you are your diet is little bit out of control so we just need to rain you in a little bit and hopefully you know with their help we can eventually get you off that lisinopril alright so do you have any questions for me [Patient] do i need to elevate my leg or stay off my leg or[SEP][Discussion][Doctor] yeah i would yeah you can elevate your leg stay off your stay off your leg you know if you have any kids have them work out in the yard instead of you just to to for a couple of weeks it's a good thing if you want to do that [Patient] tell him this doctor's order[SEP]
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[
"Discussion"
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[
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] | 356
|
[Physical Examination][Doctor] okay there is pain to palpation on the right knee and i'm just gon na move it all around does that hurt [Patient] little bit yeah[SEP][Physical Examination][Discussion][Medication][Diagnostic Testing][Acute Assessment][Doctor] okay so there is decreased flexion and extension of the right knee there is associated ecchymosis to the right medial knee there is no evidence of an effusion okay so billy what does all of that mean that means that you just have signs of that you have a little bit of an upper respiratory infection that might have caused some congestion in your in your lungs which we will talk about okay and then and as far as your knee exam it just shows that you do have some inflammation and some evidence that you had injured it earlier so let's just talk a little bit about you know my assessment and my plan for you for all of these issues okay so for your first problem of your cough you know i do believe that you just have a a viral syndrome at this time you probably have some mild bronchitis i really just wan na go ahead and just you know recommend some supportive care you can continue to take over the counter medications we can prescribe guaifenesin six hundred six hundred milligrams twice a day to help cough up some of that phlegm and i do n't think you need need any antibiotics at this time but certainly if your symptoms worsen i want you to call me and then we can go ahead and consider ordering a chest x-ray to make sure that you do n't have any pneumonia okay how does that sound [Patient] that sounds good[SEP][Medication][Diagnostic Testing][Reassessment][Doctor] okay so for your second problem of your right knee pain i do believe you have a a a right medial collateral ligament strain from the fall this morning and i really wan na just go ahead and and i'll prescribe some meloxicam fifteen milligrams once a day and we can refer you to physical therapy to help strengthen those muscles around that area and i'm gon na go ahead and just order a right knee x-ray just to make sure that you did n't injure any bones although i do n't think you did but we'll just go ahead and order that right knee x-ray how does that sound [Patient] okay that sounds like good good plan[SEP][Medication][Diagnostic Testing][Reassessment][Doctor] okay and then for your third problem of your hypertension let's just continue on the lisinopril twenty milligrams a day i wan na go ahead and order a lipid panel to make sure everything is okay from that standpoint and lastly your fourth problem your diabetes i wan na go ahead and order a hemoglobin a1c just to make sure we do n't have to make any adjustments to your metformin and i really want you to try to monitor your sugar intake and report your blood sugars to me through the patient portal how does that sound [Patient] okay i'll try that i try my best[SEP][Chitchat][Doctor] alright that sounds good i'll i'll be in touch with you with those results okay [Patient] okay appreciate it[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 357
|
[Therapeutic History][Doctor] okay do you take any oral hormone replacement therapy [Patient] no[SEP][Personal History][Doctor] okay any history of endometriosis [Patient] any history of what[SEP][Personal History][Doctor] endometriosis [Patient] no[SEP][Family History][Doctor] okay how about any family history of any gynecological cancers [Patient] i was adopted[SEP][Physical Examination][Doctor] okay okay so i'm just gon na do a quick exam of your abdomen and then perform a vaginal exam okay [Patient] okay[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 358
|
[Acute Symptoms][Doctor] and when did this happen ? [Patient] it happened , uh ... that was sunday .[SEP][Acute Symptoms][Therapeutic History][Doctor] okay . and have you tried anything for this or anything made it better or worse ? [Patient] i tried , um , putting ice on it .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 359
|
[Vegetative History][Doctor] okay and how about any nausea or vomiting [Patient] no not as of today[SEP][Vegetative History][Doctor] okay and i know you were mentioning a cough before how is it as far as walking are you having any shortness of breath [Patient] i have n't noticed any shortness of breath it just kind of seems to be a lingering kind of light dry cough[SEP][Vegetative History][Doctor] cough okay is it any mucus with it or is it a dry cough [Patient] more dry[SEP][Vegetative History][Doctor] a dry cough okay and tell me more about this sore throat [Patient] this kind of seems to be persistent comes and goes it will be worse sometimes and then others it feels better trying to drink lots of fluids[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 360
|
[Physical Examination][Doctor] okay so pain with lumbar flexion and so i'm gon na have you lie down and we're gon na do i'm sorry okay and then i see that a supine straight leg test is positive alright so for your neurological exam you said that you are experiencing pain radiating down radiating down your left leg correct [Patient] yes[SEP][Physical Examination][Doctor] alright when i touch are there any like decreased sensation [Patient] no[SEP][Discussion][Medication][Radiology Examination][Diagnostic Testing][Acute Assessment][Doctor] okay alright so patella and achilles reflexes are symmetrical alright so i received before you came in here we got an mri and so in reviewing your results it does show a disk desiccation a disk bulge with paracentral disk herniation resulting in moderate right neuroforaminal i do n't like this word neural foraminal stenosis what those complicated words is that i just said is that it seems that you have a a a herniated disk with nerve impingement so let's talk about my assessment and plan alright your symptoms are in line with a i'm sorry you have lumbar back pain at the l4 l5 disk space due to a herniated disk with radiculopathy this means that one of your disks that sits between your vertebrae like the bones in your spine is bulging out and the bulge is pinching on some nerves so that's why you are feeling that pain like radiating down your leg i'm gon na recommend something a spinal injection with a strong nsaid and called the i'm sorry and a corticosteroid i'm just gon na inject it into the lumbar spine under fluoroscopy which you can think of like an x-ray to localize the exact area of your pain this should help with the inflammation that's causing your pain i know that sounds a bit scary it this is a typical procedure that i do all the time it's in office and we can get you scheduled today if you would like so what questions do you have right now [Patient] is that something that we can do today[SEP][Discussion][Doctor] yeah i think i have time in my schedule to get it done today just you know i'm here for you right now [Patient] alright[SEP]
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 361
|
[Vegetative History][Doctor] okay okay and and so and you vomited how many times [Patient] a couple of times[SEP][Vegetative History][Doctor] okay alright been drinking a lot of coffee you said too uh is that is that starbucks i love those nitrocolbrus and starbucks we ever had those those are incredible [Patient] yeah[SEP][Vegetative History][Doctor] that's [Patient] and the venti[SEP][Vegetative History][Doctor] yeah the for sure you got ta go venti on that you really have to coax them into it though they wo n't even give you it's it's like you need a license to get a venti on that that nitro it's so strong so that's my achilles heel i tell you but okay so you think that might have you think maybe coffee contributed to your abdominal pain uh you you you you've been drinking more coffee and maybe that's related as you're thinking [Patient] yeah i think so because i started last week and towards the end of last week my coffee intake was pretty bad so i've been controlling myself this week and you know i i probably just had one cup[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 362
|
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] hi frank how are you i heard the medical assistant told me that you're having some shortness of breath [Patient] i am i am i am okay i am not great[SEP][Acute Symptoms][Doctor] you are okay you are not great okay well how long have you been having some shortness of breath [Patient] it's been about a week[SEP][Personal History][Doctor] it's been about a week okay now have you ever experienced these symptoms before [Patient] yeah this happened about six months ago and i came in and they changed my lasix dose and i seemed to get better[SEP][Personal History][Doctor] okay alright so let's talk a little bit about that now i know that you have a history of coronary disease you know you had had a heart attack back in twenty eighteen we put that stent in your right coronary artery i know that the pumping function of your heart was a little low you know that what we call that ejection fraction was about thirty five percent have you been watching your salt intake [Patient] yeah but you know it's been the holidays the last couple of weeks and you know i we've had a bunch of family get togethers and i i do n't think my diet has been everything it should have been[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 363
|
[Acute Assessment][Doctor] you're welcome . so what i think we're dealing with is right hip degenerative joint disease . [Patient] okay .[SEP][Referral][Doctor] and we do have some options . so first is to start some low impact exercises . i can provide you with a hand out with what exercises you can do . you should take nsaids as needed to help with the pain and discomfort , as well as use of a cane to help offload the right side . a cane will help support your painful side to help reduce the pain . [Patient] hmm , i do n't love that idea but i'll give it a try .[SEP][Medication][Doctor] okay , that would be great . and we can also try a cortisone injection into the right hip joint to see if that offers any relief . [Patient] i would like to definitely get the injection .[SEP][Follow-up][Medication][Doctor] okay . we can take care of that today while you're here and then schedule a follow up appointment in three months to see how you're doing , and then receive another injection if needed . [Patient] okay , that sounds good .[SEP][Discussion][Medication][Doctor] okay . and here are the risks associated with getting the inje- injection . um , please just take a moment to review it and consent to the shot . [Patient] i'm good .[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 364
|
[Physical Examination][Doctor] you can go ahead and sit up . [Patient] thank you .[SEP][Discussion][Doctor] all right , so typically the lumps would often just shrink up pretty quickly after you've had one or two cycles , and you've had two cycles so far . so i think let's just keep monitoring them for now . [Patient] okay . and what could that mean ?[SEP][Discussion][Doctor] well , so just like people have an increased risk of breast cancer , there's also an increased risk for breast issues . you know what i mean ? so for example , cysts and lumps and fibroadenomas , those are all benign things . they're annoying and require some workup , but they're all benign . [Patient] and i'm- i'm just worried because i'm almost 40 and my mom was almost 45 when she was diagnosed with breast cancer . so i mean , i know there's nothing i can do about it , but it's just i feel like , uh , we had it under control and now it is n't .[SEP][Discussion][Doctor] well , i would n't say that . i mean , i feel like we're at a point where we have a good cadence for you having surveillance on things , and i think you are more aware of your breasts than ever before , and things actually have n't changed . [Patient] yeah .[SEP][Discussion][Doctor] so those are all good things . [Patient] okay .[SEP]
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[
"Discussion"
] |
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] | 365
|
[Other Socials][Doctor] and then we'll talk more about the surgery and what it entails . and , um , at this point , who is your insurance provider ? [Patient] i have blue cross blue shield . well , actually , my husband just accepted a new job , and i will be on his plan , uh , which i believe is not going to be blue cross , but it may be changing .[SEP][Discussion][Other Socials][Doctor] okay . what we typically do when we do a breast reduction consult , i'll document your symptoms , symptoms , we'll take some pictures , then , um , they get sent to the insurance company . and what they'll do is decide whether it's approved , or medically necessary , or not . but we wan na make sure we send it to the right insurance . do you know when you'll be on the new plan ? [Patient] most likely july .[SEP][Other Socials][Doctor] okay . so we may just wait until july to submit for approval at that time . [Patient] okay .[SEP][Personal History][Doctor] so regarding your symptoms , do you experience back pain ? [Patient] well , i've been going to the chiropractor for a few years . i do have a lotta pain here and here . but i do n't know if it's all from my breasts or not . it gets painful and builds up . so i think i could attribute it to my breasts , when i'm working at my desk all day .[SEP][Personal History][Doctor] okay . and in your neck and your upper back . and how long has this been going on ? would you say five years , 10 years , or even since puberty ? [Patient] i would say since i was in high school .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 366
|
[Acute Symptoms][Doctor] okay . like , in terms of gripping things ? [Patient] yeah .[SEP][Acute Symptoms][Doctor] really ? [Patient] yeah . it does n't work properly . or , it works very rarely .[SEP][Therapeutic History][Doctor] gotcha . and did i hear that she gave you some prednisone and some oral steroids , or ? [Patient] uh , well , she gave me some numbing medicine . it helped a little bit . the other two were a neck pill and gabapentin . uh , you should have my full list in your notes , though . since then it has n't really bothered me at night . also , just so you know , i am a va and i'm one percent disabled from this leg , um , issues from my knees down to my feet .[SEP][Therapeutic History][Doctor] okay . is it neuropathy ? [Patient] uh , yep .[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 367
|
[Conversation Start][SEP][Personal History][Greetings][Doctor] patient is pamela cook . medical record number is 123546 . she's a 36-year-old female post bilateral reduction mammoplasty on 10-10 20-20 . hey , how are you ? [Patient] good . how are you ?[SEP][Personal History][Doctor] i'm doing well . it's good to see you . how have you been ? [Patient] i've been doing good .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 368
|
[Other Socials][Doctor] so is it interfering with your just things you like to do and [Patient] hmmm no not really[SEP][Other Socials][Doctor] so i know you said that you like to do a lot of travel [Patient] yeah i've got a trip planned here in the next month or so and we are going down to columbus georgia to a a lion's club function and probably be doing a lot of walking there and they got some line dances planned and i do n't think i will be able to participate in that because of the knee[SEP][Other Socials][Doctor] is that where you would be kicking your leg out or something [Patient] no it's do n't you know what line dancing is like dancing in theories of fairly fast moves but it's mostly sideways motion[SEP][Other Socials][Doctor] and is and that you think that's when your knee might give out then or just not gon na take the chance [Patient] not gon na take the chance[SEP]
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] | 369
|
[Lab Examination][Doctor] so it just needs to be checked every year or so . [Patient] so in terms of , uh , estrogen control i've been hearing that indole-3-carbinol , or broccoli extract , supposedly can improve my estrogen levels . have you ever heard of it ?[SEP][Discussion][Doctor] yeah , i've heard of it but i have n't had anybody consistently use it . i mean , your levels are fine and we checked your estra- estradiol and it was not elevated , so . [Patient] okay .[SEP][Discussion][Diagnostic Testing][Doctor] i would argue that we could test that in the fall if you want , but we do n't need to do , uh , do any more tests ... any more than test once a year , excuse me . [Patient] okay , what about increasing my testosterone to 175 milligrams ? i'm at 140 now .[SEP][Lab Examination][Doctor] well , your levels are high . [Patient] are they right now ?[SEP][Lab Examination][Doctor] well , i mean they were last time . [Patient] yeah but i just- just injected though , or i had right before that was taken .[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 370
|
[Conversation Start][SEP][Greetings][Doctor] hi alan , how are you ? [Patient] hi , good to see you .[SEP][Chitchat][Doctor] good to see you as well . are you ready to get started ? [Patient] yes i am .[SEP][Acute Symptoms][Doctor] so , alan is a 61-year-old male , here with complaints of shortness of breath . so alan , what's going on ? [Patient] so over the weekend , uh , i took a very long bike ride , about three hours or so and i got back , i was very light headed , i was short of breath and it really surprised me because i pretty much bike ride every morning and it was never an issue before so i'm a little concerned about that .[SEP][Acute Symptoms][Vegetative History][Doctor] okay , and have you had any other symptoms ? have you had any fever- [Patient] no-[SEP]
|
[
"Acute Symptoms",
"Vegetative History"
] |
[
"Subjective"
] | 371
|
[Acute Symptoms][Doctor] mm-hmm , like right on your shoulder . [Patient] yeah .[SEP][Acute Symptoms][Doctor] that sounds like it hurt . [Patient] it was nasty .[SEP][Acute Symptoms][Doctor] um , so this happened , what ? like 12 hours ago now ? [Patient] uh , seven o'clock last night , so a little more than that .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 372
|
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] so tyler is a 56 -year-old male who presents today complaining of difficulty swallowing and has a past medical history of diabetes and high blood pressure so tyler tell me what's going on with your swallowing problem [Patient] well it's just been something that i have noticed over the last you know four to five weeks it seems like something is always stuck in my throat and you know just i kinda go about my day and it kinda bothers me you know a little bit sometimes a little painful and when i try to eat it just seems like i have to i do n't know when it's something solid i kinda have to wash it down on occasion i i've never really fully choked but i have to admit that i've thought about potentially choking[SEP][Acute Symptoms][Doctor] okay and is it seem to be stuck in your throat or does it seem to go in your lungs area or are you coughing with this at all or just mostly when you're swallowing [Patient] no coughing just kinda when i swallow it's all okay with liquids but when i kinda swallow you know like a bite of a sandwich sometimes it just feels like like i just need a little help pushing it down[SEP][Acute Symptoms][Doctor] okay and is it more kind of a like heart like steaks or heart like larger solid like things that are that you have to chew more or is it even soft stuff like you know to eat yogurt and stuff like that [Patient] i'm not a hundred percent sure but i think it's probably more with solids[SEP][Acute Symptoms][Doctor] okay how about have you noticed anything different with when you're swallowing cold or or or hot liquids is there is there a temperature change any modification to that [Patient] it's really just about solids[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 373
|
[Drug History][Doctor] okay alright how about smoking have you ever smoked [Patient] i do smoke i'm down to one to two cigarettes a day it's just really been tough to just get rid of those two but i've cut down a lot i used to i was up to one point or a pack and a half a day[SEP][Chitchat][Doctor] wow okay alright so yeah you you definitely have decreased that so that's again good for you on that one so hopefully you keep you keep that up [Patient] thing[SEP][Personal History][Doctor] so tell me do you have any other medication conditions [Patient] do i do i no otherwise i'm i'm feel pretty good i had my physical there was nothing else the the only thing i was telling my pcp is i do feel like tend to be really tired at the end of the day after working but otherwise i've been good[SEP][Other Socials][Doctor] okay and and has work been not hard lately you've been busy it sounds like [Patient] i know i have been busy but not really much more than usual[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 374
|
[Conversation Start][SEP][Personal History][Greetings][Therapeutic History][Doctor] tyler nelson , date of birth : 3 , 6 , 1949 , mrn , 385729 . he is here today for ongoing management of rheumatoid arthritis . last time he was here , he received a steroid injection in his right knee . hello mr. nelson , how are you ? [Patient] um , about the same as last time . my knee is still swollen .[SEP][Personal History][Therapeutic History][Doctor] that was your right knee , correct ? i take it the injection did n't help ? [Patient] it did , maybe for a couple of weeks .[SEP][Acute Symptoms][Doctor] that's it ? and is it still painful ? [Patient] yeah , it's pretty painful , and now the whole leg is getting swollen .[SEP]
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[
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[
"Subjective"
] | 375
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[Acute Symptoms][Doctor] wow that's pretty bad does it keep you up at night [Patient] yes it really does it's you know if i roll over and it it it just wakes me up[SEP][Acute Symptoms][Therapeutic History][Doctor] okay have you done anything to relieve the pain [Patient] well i have been taking some ibuprofen but that is n't really helping[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and have you tried anything like ice or heat or anything else [Patient] i tried a little bit of ice at first[SEP][Acute Symptoms][Therapeutic History][Doctor] mm-hmm [Patient] but and it's just it's been hurting for about four days now[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 376
|
[Vegetative History][Doctor] a dry cough okay and tell me more about this sore throat [Patient] this kind of seems to be persistent comes and goes it will be worse sometimes and then others it feels better trying to drink lots of fluids[SEP][Vegetative History][Doctor] okay and when you mention drinking and eating is do you feel like anything is getting stuck there [Patient] no i do n't feel like anything is getting stuck right now and i have n't been i have been eating but not as much as i normally would[SEP][Other Socials][Doctor] okay okay alright and how are you doing as far as like just emotionally and mentally how are you doing i'm just talking a little bit about your support systems [Patient] the nursing staff and the office has been very good to help you know with anything that i need as far as support so just since we are just getting started so far on the journey i do feel like i have support and mentally you know still feel strong[SEP][Other Socials][Doctor] okay and how about with family or friends have you been able to turn to anyone [Patient] i do have good family members that have been supportive and they have come to my treatment with me[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 377
|
[Acute Symptoms][Doctor] so in the area of your mid abdomen , just below the belly button ? [Patient] correct . i've had the pain on and off for about two years . i finally went to the er and a ... a few months ago and they did a ct scan .[SEP][Acute Symptoms][Doctor] i saw that . [Patient] yeah . they said they did n't really see anything on the scan .[SEP][Acute Symptoms][Vegetative History][Doctor] yes , i agree . it looked normal . [Patient] the problem is i'm either constipated or have explosive diarrhea .[SEP][Acute Symptoms][Doctor] is the pain there all the time ? [Patient] it's a nagging feeling and it just depends . sometimes it bothers me , sometimes it does n't .[SEP][Acute Symptoms][Personal History][Doctor] has this been the case over the past two years as well ? [Patient] more recently in the past couple months , at least with the constipation and diarrhea .[SEP]
|
[
"Personal History",
"Vegetative History"
] |
[
"Subjective"
] | 378
|
[Acute Symptoms][Doctor] okay . when did these four days of chest pain occur ? [Patient] um , early october .[SEP][Acute Symptoms][Doctor] of 2020 , correct ? [Patient] yes .[SEP][Acute Symptoms][Doctor] okay . can you think of anything that might have caused the chest pain ? did you wake up with it ? [Patient] no . it just it randomly . i tolerated it for four days but then had to go to the emergency room because nothing i did relieved it . they did a bunch of testing and did n't find anything .[SEP][Acute Symptoms][Doctor] okay . can you point to the area of your chest where the pain was located ? [Patient] well , it was here in the center of my chest , right behind my breastbone . it felt like i was having a heart attack . the pain was really sharp .[SEP][Acute Symptoms][Therapeutic History][Doctor] did they prescribe you any medications in the er ? [Patient] no . they ran an ekg and did blood tests , but like i said , everything was normal .[SEP]
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[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] | 379
|
[Personal History][Doctor] great . how about your breasts , are they doing all right ? [Patient] great .[SEP][Vegetative History][Doctor] are you having any chills , fever , nausea , or vomiting ? [Patient] no .[SEP][Chitchat][Doctor] good . all right . let's take a peek real quick . [Patient] sure .[SEP][Other Socials][Doctor] how's life otherwise ? pretty good ? nothing new ? [Patient] no , just enjoying summertime .[SEP][Chitchat][Doctor] okay . how's your family ? [Patient] they're good .[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 380
|
[Acute Symptoms][Doctor] okay . well , that's really good to hear . i'm glad . are you having any new symptoms right now ? [Patient] no , not really . but , you know , i'm still getting some chest pains sometimes , and my breathing gets shallow . but , i guess i'm learning what i can and ca n't do . uh , so if i feel like that , if i'm , like , exerting myself , i slow down a bit which helps , and then when i go back to it later , i can usually finish whatever i was doing .[SEP][Acute Symptoms][Doctor] okay . so , it does go away though ? how long does an episode seem to last ? [Patient] uh , only a few minutes i guess . then it disappears for a while . it's weird .[SEP][Acute Symptoms][Doctor] what is a while ? [Patient] it goes away for a couple weeks . um , so when it happens , i just take the day nice and slow , i do n't push myself .[SEP][Acute Symptoms][Doctor] okay . so , maybe it's a couple times a month you feel this way ? [Patient] yeah , just often enough for me to notice .[SEP][Therapeutic History][Doctor] understood . okay . are you taking your medications regularly ? [Patient] uh- . i've been trying to keep up with that . there's a lot of extra pills now , but i have a reminder app , so i do pretty well .[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 381
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[Physical Examination][Doctor] okay . range of motion is decreased in exertion . lateral flection without pain . any pain when i push ? [Patient] no .[SEP][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"
] |
[
"Objective"
] | 382
|
[Vegetative History][Doctor] any burning when you urinate ? [Patient] no .[SEP][Vegetative History][Doctor] any joint pain or muscle aches ? [Patient] no .[SEP][Personal History][Doctor] perfect . um , and then , i know that you have this history of a-fib , atrial fibrillation . have you felt your heart racing at all , recently ? [Patient] only when i'm really anxious . i , i feel it , um , pumping a little bit . but other than that i have n't .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 383
|
[Greetings][Doctor] hey hi bobby how are you doing [Patient] i'm doing good how are you[SEP][Acute Symptoms][Doctor] i'm doing fine so i understand you're here having some left or some right shoulder pain that you've had for a few weeks now [Patient] yeah it was i was doing some work in my backyard and a lot of different projects going on and you know i was obviously sore all over the next couple of days but my my right shoulder just keeps on bothering me and it keeps it's just really sore and it just has n't been going away[SEP][Personal History][Doctor] okay so have you had ever had any pain in that shoulder before [Patient] a little bit i you know i i hurt that same shoulder because it's my my dominant hand my right hand i hurt it playing baseball when i was younger[SEP][Personal History][Doctor] mm-hmm [Patient] so i've always had a little bit issues but this is it's does n't feel like it's in the rotator cuff it's it's kinda more on the outside and it's kinda like it's more tender on the outside when i raise my arm up so[SEP][Acute Symptoms][Doctor] okay yeah are you able to move your arm very well or not [Patient] yeah there is no restriction with my arm it just i definitely feel some pain on the outside of it[SEP]
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[
"Acute Symptoms"
] |
[
"Subjective"
] | 384
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[Acute Symptoms][Doctor] okay it kinda try let's let's try describing the pain for me please [Patient] yeah it's kind of feels like it's like right behind my kneecaps[SEP][Acute Symptoms][Doctor] a deep achy pain okay what kind of activities makes the pain feel worse [Patient] let's see so anytime so if i'm sitting at my desk and i get up i have a lot of pain so anytime from like standing up from sitting for a while or even going up and down the stairs[SEP][Other Socials][Doctor] okay so you work from home [Patient] i do[SEP][Other Socials][Doctor] okay okay so there is a lot of desk setting at home is your office upstairs or is it i mean do you have to go up or downstairs to get to it [Patient] no well first thing in the morning but otherwise it's downstairs[SEP]
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[
"Other Socials"
] |
[
"Subjective"
] | 385
|
[Physical Examination][Doctor] all right . and go ahead and straighten out as much as you can . [Patient] that's about it .[SEP][Chitchat][Doctor] all right . [Patient] yeah .[SEP][Physical Examination][Doctor] so there's some swelling there . and how about , uh , can you move your fingers okay ? does that hurt ? [Patient] no , that's fine .[SEP][Physical Examination][Doctor] how about right over here ? [Patient] uh , no that's fine . yeah .[SEP][Physical Examination][Radiology Examination][Acute Assessment][Discussion][Medication][Other Treatments][Doctor] okay . so on exam you've got some tenderness over your lateral epicondyle . uh , you have some swelling there and some redness . uh , you have some pain with flexion , extension of your elbow as well . uh , and you have some pain on the dorsal aspect of your- of your forearm as well . okay ? so let's look at your x-rays . hey dragon , show me the x-rays . all right . your x-ray of your elbow-it looks like , i mean , the bones are lined up properly . there's no fracture- . it , uh , there's a little bit of swelling there on the lateral elbow but i do n't see any fracture , so that's good . so , looking at the x-ray and looking at your exam , uh , my diagnosis here would be lateral epicondylitis , and this is basically inflammation of this area where this tendon in- inserts . and probably that happened when you were moving those boxes . so we'll try some motrin , uh , about 800 milligrams every six hours . uh , i'll give you a sling for comfort , just so you can use it if- if it's causing a lot of pain . [Patient] hmm .[SEP]
|
[
"Discussion",
"Follow-up"
] |
[
"Plan"
] | 386
|
[Acute Symptoms][Doctor] okay . just when swimming ? are you swimming freestyle with your legs kicking straight or more like breaststroke where your legs kick out ? [Patient] yeah , it's only while swimming. i use the breaststroke so i guess where the legs are kicking out like a frog ... it kinda starts hurting a little bit after i swim a couple laps , which a month ago when i started i was able to do ten .[SEP][Acute Symptoms][Doctor] and no injury ? like you did n't fall or twist it or anything like that that you remember ? [Patient] no , not that i can remember .[SEP][Acute Symptoms][Doctor] okay . so just swimming a lot and you feeling more and more discomfort ? [Patient] yeah .[SEP][Personal History][Doctor] okay , good . so , um ... i know my nurse did a review of systems before you came in . there were really no significant issues . you have a history of chronic back pain , that's been doing well ? [Patient] yeah , it comes and goes , but right now it's been doing really well .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 387
|
[Vegetative History][Doctor] okay . and how about any recent weight gain or anything else like that ? [Patient] um , i lost a little bit of weight , but i still weigh a 120 pounds , but i normally weigh about 130 pounds .[SEP][Vegetative History][Doctor] mm-hmm . okay . [Patient] um , but that's been going down gradually for about a year .[SEP][Vegetative History][Doctor] okay . and then how about any fevers , chills or anything else that's , that's going on that you can think of ? [Patient] no .[SEP][Acute Symptoms][Doctor] good . so mainly it sounds like you came in , um , mostly because of the murmur . is that right ? and sort of just kind of seeing what things look like ? [Patient] yeah , that and i feel overly tired because i take all that medication .[SEP][Personal History][Doctor] okay . and so fatigue as well . and have you ever had any testing of your heart done ? [Patient] i'm not really sure .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 388
|
[Conversation Start][SEP][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"
] |
[
"Subjective"
] | 389
|
[Conversation Start][SEP][Greetings][Doctor] hi , andrew , how are you ? [Patient] hi . good to see you .[SEP][Chitchat][Doctor] it's good to see you as well . so i know that the nurse told you about dax . i'd like to tell dax a little bit about you . [Patient] sure .[SEP][Acute Symptoms][Personal History][Doctor] okay ? so , andrew is a 62-year-old male with a past medical history significant for a kidney transplant , hypothyroidism , and arthritis , who presents today with complaints of joint pain . andrew , what's going on with your joint ? what happened ? [Patient] uh , so , over the the weekend , we've been moving boxes up and down our basements stairs , and by the end of the day my knees were just killing me .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 390
|
[Chitchat][Doctor] okay alright well i have a peloton who is your favorite instructor [Patient] i i actually do n't have a favorite instructor i have more favorite rides[SEP][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"
] |
[
"Subjective"
] | 391
|
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] patient shirley taylor . date of birth 5/4/1961 . mrn 0000123 . patient is a 60 year old right-handed female new patient referred by dr. jacob ward for evaluation of bilateral hand numbness and tingling . please note that i personally reviewed the ct brain with and without contrasting did 2/5/21 . uh , no metastatic disease . no acute intercranial abnormalities . hello ms. taylor . how are you doing this morning ? [Patient] hi dr . lopez . this weekend was a bit rough . i've had this numbness and tingling for a few weeks now .[SEP][Personal History][Doctor] so , in both of your hands ? [Patient] yeah . ever since my car wreck last december when i broke them . well , once they heal , i mean , i noticed it more , the , the tingling and numbness .[SEP][Personal History][Doctor] are you still wearing the splint only on your right wrist ? [Patient] no . i wear the left one also sometimes . the right one's just worse . the splint seems to help . both have gotten worse over the last month . when i broke them though , my wrist was definitely in worse shape than it is today . i've been having some mild stiffness in my neck too . i hit my head during the accident , and they told me it was a contusion .[SEP][Acute Symptoms][Doctor] okay . and where exactly on the right side would you say the tingling and numbness is ? [Patient] on the right , i can really notice it from my middle and ring finger all the way up to my forearm , and on my left , a bit more the pinky and the ring and not the middle .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 392
|
[Physical Examination][Lab Examination][Doctor] can you push your leg out ? push this one up . pull it back . yeah , good . okay . so on my exam , um ... your exam's essentially normal , your lungs are clear , are- ... you do n't have any adenopathy in your neck , you do n't have any , um , uh , hyperthyroidism . um , your heart is regular without any murmurs . um , your grips are equal , neurologically intact , strength is good , pulses are good . so overall , um , your exam is fine . let's take a- a look at some of your labs and vital signs . [Patient] okay .[SEP][Discussion][Follow-up][Medication][Lab Examination][Reassessment][Doctor] hey dragon , show me the blood pressure . okay , so here in the office today it is a little bit elevated , okay ? so your blood pressure is a little bit high . so the results , um , do show that . um , hey dragon , show me the labs . okay , so good news is is your- your labs are all essentially normal , so the results of your labs are essentially normal , okay ? so ... um , my assessment is that your- ... you do have hypertension still . um , and i think we need to increase your blood pressure medicine a little bit , okay ? so i'm gon na increase your lisinopril to 10 milligrams a day , just once a day , um , but i'm gon na increase that a little bit , okay ? and then want you to check it and i'm gon na have you come back in a month and we'll see how you're doing with regards to that , okay ? [Patient] okay .[SEP][Discussion][Reassessment][Doctor] um , your second problem is your dep- depression , you're doing great , i do n't wan na change anything at this point . let's just stay- ... we'll change one thing with your high blood pressure- [Patient] mm-hmm .[SEP][Discussion][Medication][Doctor] so i do n't wan na change any other medications at this point in time , so let's just leave that as it is . [Patient] okay .[SEP][Discussion][Follow-up][Reassessment][Doctor] and then your third problem was your carpal tunnel . that seems to be doing well . if you notice any tingling or any changes or you get some of those symptoms back , just let me know . okay ? [Patient] okay .[SEP]
|
[
"Discussion"
] |
[
"Plan"
] | 393
|
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] karen nelson is a 3 -year-old female with no significant past medical history who comes in for evaluation of a new right eye twitch karen is accompanied by her father hi karen how are you [Patient] i'm okay i guess[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 394
|
[Physical Examination][Doctor] great . so mister i would like to do a physical exam if that's okay with you [Patient] sure[SEP][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"
] |
[
"Objective"
] | 395
|
[Personal History][Doctor] awesome . okay . [Patient Guest] and we also have speech therapy , who is going to be starting within the next couple of weeks .[SEP][Personal History][Doctor] that's great . [Patient Guest] so , she has a lot of therapies . we have also seen an orthopedic and an ophthalmologist . i can never say that . we have seen everything , really .[SEP][Personal History][Doctor] and audiology too , right ? [Patient Guest] yes .[SEP][Personal History][Doctor] yeah , wow. . [Patient Guest] yeah , it has definitely been a whirlwind of stuff . when we saw the geneticist , she told us that sometimes people with this syndrome , they have trouble with their kidneys . that they might actually fuse into one . she also said sometimes they have problems with their legs , so that was why we saw ortho .[SEP][Personal History][Doctor] okay . okay . [Patient Guest] so we have seen everybody , really . we are just here to make sure that her kidneys are looking good right now .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 396
|
[Acute Symptoms][Therapeutic History][Doctor] okay have you taken anything for the pain yet [Patient] i tried some tylenol yesterday[SEP][Acute Symptoms][Therapeutic History][Doctor] alright did that work for you [Patient] a little[SEP][Acute Symptoms][Therapeutic History][Doctor] little do you have any [Patient] being off of it help more than anything[SEP][Acute Symptoms][Doctor] yeah i be i bet i bet i i hurt my knee before too and it's it's pretty painful on a scale of one to ten what would you say your your pain level is [Patient] it's about a four right now[SEP][Therapeutic History][Doctor] about a four okay so it's it's not too bad alright so we'll take a look at that knee in a second so we're also here to check up on your hypertension and diabetes so i'm looking here for your hypertension you're taking five milligrams of norvasc so are you taking that daily [Patient] yes[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 397
|
[Acute Symptoms][Therapeutic History][Doctor] no shortness of breath okay and what have you been doing for your cough [Patient] i've just been kinda drinking lots of water taking some cough medication over the counter and it seems like it's not really working[SEP][Personal History][Doctor] it's not helping okay and tell me do you have any history of any seasonal allergies [Patient] right around spring time i get a little bit of sneezing and the runny runny nose[SEP][Vegetative History][Doctor] okay okay and then any how about any body aches for you [Patient] no body aches[SEP][Vegetative History][Doctor] nausea or vomiting [Patient] no[SEP][Personal History][Doctor] okay alright so we will definitely examine you and talk more about that and as far as your diabetes how has everything been going with that checking your sugars how has that been going [Patient] i've been pretty good at checking my blood sugars they've been running around one twenty range[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 398
|
[Therapeutic History][Doctor] okay . so , you're currently taking vitamin d3 , around 5000 units on sundays , and two thous ... or 50,000 units on sundays , excuse me , and 2000s on the other six days , and then clindamycin prior to dental procedures , correct ? [Patient] yeah , that's right .[SEP][Therapeutic History][Personal History][Doctor] have you had a covid-19 shot yet ? [Patient] i've received both . my first dose on january 15th , '21 and my second on february 5th , '21 .[SEP][Physical Examination][Diagnostic Testing][Acute Assessment][Referral][Doctor] good . if you'd hop up here on the table , we're just going to do a physical exam . well , mr. walker , overall you're doing well . i'm going to order an echocardiogram and a stress test . i also recommend that you follow up with cardiology , i think dr. vincent sanchez would be a great fit for you . [Patient] all right .[SEP][Lab Examination][Doctor] also your recent labs showed an elevated alkaline phosphatase level at 156 . now this could be related to your liver but most likely related to your bone health . we're going to check a few labs today . [Patient] you're going to have them done today ?[SEP][Discussion][Diagnostic Testing][Doctor] yes , sir , and we will send the results through your patient portal unless something is way off then we'll give you a call . [Patient] sounds good .[SEP]
|
[
"Diagnostic Testing",
"Referral"
] |
[
"Plan"
] | 399
|
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