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You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hey Paul, sorry about the delay. Okay so we scanned it into your chart. You don't want to have the images with you by any chance. No I'm doing those tomorrow. Okay that's totally fine. So we did the x-ray for you here. We do see that scapular fracture is coming right over here. Looking at your... report they call it minimally displaced so most of the time probably 90 something percent of the time um as long as it's minimally displaced we actually don't do any surgery for a scapula fracture but kind of walk me through exactly what happened because of isolated scapula injury it's pretty rare third doctor didn't say that yeah yeah so what happened playing soccer a guy was going in for one-on-one i dove to get the ball i landed on this shoulder I'm crawling up to get the ball. He, knee or shin or something is straight into my scapular. Oh, going full speed. So it was just both of us climbing full speed. So you were trying to like... Yeah, I was down on the ground like this and just came in and like... Just directly knee'd you right there. Yeah. Okay, got it. Pain immediately. Immediate pain, no pain in my scapular though. All the pain was like, maybe this was just referred pain, but it felt like it was just deep inside my shoulder. Yeah. Itself. Gotcha. But the first thing I did, like even when I was on... I'm riding in pain was to make sure I could move my shoulder in every direction. So I didn't have any loss of movement at all. Okay, good. You didn't feel like your shoulder popped in and out, anything like that. I didn't feel it popping out. I heard a lot of pop. I put it in my scapula, just been the collision. Yeah, yeah. I heard a lot of noise, but I didn't know what it was. I didn't feel it go in and out and then I could move it the whole time. Yeah, there was just a shooting pain there. The pain went away after about two hours. Are you still asleep? No. Okay. I can't lift my arm above it here without major pain. Okay. Bye. I went to the ER after the game. The pain went away after about a week. The leg after two hours. Now it only hurts. If I don't have the sling on, and I'm bathing or something, and I move my arm a little bit too fast, then I'll have pain. Otherwise, there's no pain. Let's take a look on Jay's. We're going to do a very limited exam today. Just because of the fracture. I'm going to go ahead and just push it. in some areas. Is that kind of tender? Nope. That's okay? Mm-hmm. That's still fine. Yep. Okay. You actually don't have that much discomfort with me pushing on your scapula. No, that's why I was shocked the scapula was broken. Yeah, that's okay right? Yep. Okay. And nothing along the clavicle itself. Nope. That's okay. Right here. But AC joint. Yep. Slightly lower than that is where it was hurting. Like right here, right deep inside the socket is where I felt the initial pain. But now there's no pain. Okay. All right. Yeah. The pain looks otherwise pretty good. You know, usually we try to check to see whether or not there are any other injuries, usually like a clavicle injury, AC joints, things like that shoulder dislocation, but you don't really have much pain over there. Um, so let's. For something like this, typically we keep people in a sling for comfort for about two weeks. At which point we're going to see you back. If everything still looks good, if you still have minimal pain, then we actually can discontinue the sling and we're going to get you to physical therapy pretty soon. So we can start with an early range of motion, usually about six to eight weeks. Most people do recover pretty well with this. Okay. Yep. I have a question on the sling for comfort. What's that? I mean, in the sense of like, if I'm, obviously when I'm walking around, where the sling, if I'm just sitting on the sofa, is it where the sling is? Does it take the sling off? That's totally fine if you're sitting, you know, like a computer chair or a sofa, you can just rest your arm and you're feeling totally fine, that's okay. Okay. You can get out of the sling. Okay. All right. Let me give you a couple of things, right? First and foremost, we're gonna give you a PT referral. So you can try to start scheduling for an appointment. So that as soon as you get out of the sling, you can actually start doing some gentle range of motion. Okay, because really what happens is that when you when we kind of immobilize you for For a little bit your shoulder gets really really stiff and people start losing range of motion So about two weeks out, you know Once you're starting with to move your arm a little bit better Then you can start doing this extra range of motion exercises going forward external rotation things like that And then they will start working on strengthening your arm or shoulder so that you can back go back to doing things that you want to do All rightalk … TLaughs Here you go, so that's yours. Okay, so any questions about everything that's going on so far? No, one real question I have is about if I'm allowed to take the center off while I'm sitting on the sofa. Yeah, that's totally fine. Okay, so let's go ahead and see you back in two weeks. Perfect. Just give this to a lady up front so that they can make you fall off. plan for you in two weeks. Okay? Awesome. Well good to see you and sorry. Please insert a left shoulder forward view x-ray that shows a fracture line noted to the inferior of the scapular spine. Please insert a limited left shoulder exam with no focal tendons palpation over the scapula and inferior to the scapula. No tendon is palpation over the clavicle or over the AC joint. So that's not a plan, this is a 35 year old male patient presenting for initial consultation of a minimally displaced left scapular body fracture that occurred after he got knee directly in the scapula while playing soccer. on 3-9-24 period. Patient was evaluated at the ER and had a CT done that is notable for minimally displaced fracture of the left scapular body and period to the scapular spine period. A few patients left shoulder x-ray today which showed the fracture line. But otherwise, no clavicle fracture or other fracture or dislocation noted, period. With a consultation that isolated scapula, fracture are rare but can usually be treated conservatively. minimally dyslexia period but it's just about placing him in the sling for two weeks followed by early range of motion and we'll provide him with a physical therapy referral to help with his range of motion when he gets out of the sling in two weeks period. We plan to see patient back in two weeks for repeat x-rays. and... evaluation. Period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 32 year old female with history of lumbar microdiscectomy presenting for follow-up regarding acute back pain and ridiculous symptoms. Alessandra? Hello Lindsay here. Hi. Good to see you again. How are things going? Not much better. Okay. Yeah I'm still just like in a lot of pain. Today I woke up and like my leg is been tingling and so I'm forced to believe that it's definitely not... getting any better and you know it's just taking a while for the MRI and stuff so I was just hoping to get like the med pack really really did help. Okay. A lot with the pain like right away. Okay. So I was hoping to get another one just in the interim and I did mention to the receptionist that they had said that they didn't know I had back surgery when I called my insurance so then I had my surgeon send over you. Yes. I wrote on this morning. Information, so hopefully they said that if they know that there's back surgery, they'll approve it right away. Okay, and I have that in my note. So they just don't read the note, which is so atrociously annoying. It's like, if you just read it, they won't tell you all the information. Yeah, let me discuss that. And then when I did call your office, they said that, I think I spoke with somebody else, they said they needed the denial of. the denial of the claim first before they could send it. But I was just hoping that you guys could send it because they provided the correct fax number and stuff. And they said, just send it over and we'll just apply it to the file. There's a claim number. So like they have to send us the claim number. They have to add the service orders. Oh, okay. Okay. We just called Eugene our rough there. And he said that he's going to find it and send it over to us. So he's looking for it right now. Yeah, because I've like, I've like spoken to the, you know, the whole like. you know, insurance and stuff. Like it's just hard to get in touch with the right people, but I'm like giving them your fax number. They're saying they faxed it over, so I'm like, at this point I'm like, I'm just so, you know, I just wanna get it done. So I'm like, I just am like, if you could help with the just pushing it along, cause I'm just like at my wits end, I'm like, you know, how much longer? And it's very painful. I'm like, I just have to like live with it now, you know? Which sucks, but yeah. Yeah, so I'm just a little bit concerned with, you know, it not getting better. I've been seeing a chiropractor for a couple weeks. You know, it's like provides kind of like temporary relief for like the day, or not even really the day, for like a minute, like just to feel like it was stretched or something, but honestly, like, I don't think anything's really like changed except for today. You know, it's been like literally tingling down my leg. So I think hopefully it's not getting worse. but I know it's certainly not getting better. Did that tingling go away with the mental health? It still, no. I mean, it's still like, I can feel it down my leg to here. I mean, when I woke up, it felt like my whole leg was asleep. And you know, now when I'm walking, I can almost feel it down to my knee. So it's pretty significant pain. I mean, as much as that pain can be, and then every time from sitting to sitting, there is no comfortable position. to sit in, like I feel it. If I put my knee up, if I sit this way, I can't sit on my back, I can't sit on my stomach, I sort of lay, and then like sitting is uncomfortable no matter how I sit, but every time I sit to stand, it's like an intense cramp, like down my leg. And unless I like press here while I stand up, but still like sometimes it's like after the fact, it'll just radiate. So it's just, yeah, I mean at this point, it's just like living with it. which is annoying but but yeah so anything that I could kind of have just for the interim while they kind of sort out this MRI stuff and just to kind of get through the next week or so would be great. When did you finish the mental dose pack? Within like I took it like all I took the first dose that night okay 19th and I think I finished it on a Sunday. Okay so you've had two weeks off of it? Yeah. Okay. Yeah, I would say like this last couple days is when it's like really escalated But it's never it never like went away just kind of yeah more manageable and the only time I was like really bothering me Again sitting always is painful and I can only sleep on my side with my leg propped up with the pillow On each side but like I typically sleep on my back and I just can't sit on my back Massage I was just very uncomfortable because I'm on my back or on my stomach. So yeah, I'm just trying to, you know, without, you know, it's hard to convey how much pain without, you know, just kind of being like it just really hurts. So yeah, anything you can do to help would be great. I'll send the refill then that goes back. I don't want to do a third if we can avoid it, but yeah, let's do a refill. Maybe take off your shoes. I just want to see if there's any strength deficits that are showing up. Um, and is there. I guess it's just like, hopefully it will impact you a little bit. Yeah and then let me just have you sit for me. Okay push out against me and hold good and then pull back towards you. Good bring this foot up don't let me push down. Good push into me like a gas pedal. And then push in the knee. And then bring the knee up for me. Let me push down. And then on this side. And then sensation wise, does me touching here feel different than over here? No. How about down here versus here? No. Or on the inside here? No. How about like right here compared to right here? No. Anything here? Or are you just touching both? Yeah. Yeah. OK. And then on the outside? I mean, I've lost some feeling in my right side a little bit. So I don't know if they do feel different. I don't know how exactly. OK. Is that new, or is that from? That was from my previous video. OK. OK. Yeah, let's send Meddle those back. Eugene is super, super responsive about Simon and stuff, so he should call us back very soon. If they need me to do a prior op, I'll have him now. I'll call them, and I'll try to do it by the end of the day. OK. So that I can send them over to you. give me an off number. Yeah. And if you could send the, uh, I have to run to another appointment at like four 30. So if there's any way you could put in the prescription, y'all do it right now for you. Any change of pharmacy or pharmacy? Um, actually, yeah. Can I, I'll have Amelia do it upfront. Cause she inputs it with a big iPad for me. Um, the only thing like strength wise is like when I'm lying down, I feel like I can't like lift my leg because about, I don't know, it's probably, it's just stretching that nerve. if you wanna go in there. So, but I have to move my leg like that. Not that it's literally, obviously you can see it's not like, it's literally non-usable, but it's like I can't, yeah. It's just probably also I'm trying to avoid pain, so it's probably just me. But yeah, I haven't been able to do that in a month, probably over a month. So yeah, but otherwise, yeah, I mean, I can like survive. but it's like it's definitely getting to a point where it's like, you know, just the day to day just sucks. Yeah. Yeah. So just hopefully we can sort it out or like, I don't know what hopefully we'll figure out from them. Right. But I think that at least really some stuff will do. I will send that to you right now. Okay. And then we'll work on figuring out what needs to be done for them. Right. For you. All right. Thanks. Of course. Yes. Thanks for coming in so we can get it all sorted out. Thank you. Bye. She's going to change her pharmacy. So can we confirm that? And then, yeah, let me know what we need to do via MRI. Oh, is that him? Please copy forward prior examination. And add that there is four out of five strength to the FHL. Please, for assessment, this is a 32-year-old female presenting for a follow-up regarding. acute low back pain who has a history of a lumbar micro disectomy of bilateral l5 s1 that occurred on march 30th of 2017. Patient had acute pain with a radicular symptom and is now starting to show neurovascular deficit. I would like to order stat MRI however this has been struggled to get through insurance. I am going to send her a refill. of her medral dose pack to hopefully aid in symptomology and we are going to resubmit for MRI. She will follow up for review once the report is ready. Please then, stat lumbar spine MRI without contrast. Evaluate for disc herniation. This is going to go to Simon Med." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The colon is 2 weeks 5, 3 days post-op, 2 weeks 3 days post-op. Plus arm, proximal humerus, cast fracture, history of metastatic melanoma." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The patient is a 29-year-old male who presents a clinic for initial complaint of intermittent right knee pain over the past two months, exacerbated with squatting and bending movements, period. The patient denies having a knee-specific injury to his knee and reports he's had difficulty returning to activities such as squats due to a dull ache located around his kneecap, period. He reports he's able to commit other activities such as biking and walking without any discomfort, period. He denies having any prior history of right knee pain. Please enter a right knee physical exam with, or sorry, right knee x-ray series with benign findings. Please enter a right knee physical exam with benign findings. For assessment and plan, patient is a 29-year-old male who presents a clinic with an initial complaint of ongoing intermittent right knee pain over the past two months, exacerbated with squatting and bending movements, period. Both x-ray imaging and physical exam are relatively benign today, period. Discuss with the patient that I believe he's dealing with patella femoral syndrome likely exacerbated with his squatting exercises at the gym, period. discussed with the patient that I'd like to trial a course of conservative treatment including activity modification, comma physical therapy, comma and a course of anti-inflammatories period. The patient agreed to this plan and will return for follow-up in six weeks to evaluate his progress period. Please send a general referral for physical therapy for right knee patella femoral syndrome. Please send education on patella femoral syndrome." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " So if I understand correctly, kind of a maybe a diabetic foot checkup and also some issues with a couple of the nails give you trouble? Yeah, just anyone, but I told the nurse that I'm sorry, like fake toenails, I don't know what you mean. Okay. So you probably won't be able to see it today. Okay. Well, how often do they get? Is it a common issue or? Yeah. What do you do? forward anything? I'm not supposed to but I'm just trying to take it out. You've cloped them out of there? Okay. Are you usually able to get it? Yeah. Yeah. Okay. Is it just the big toenails primarily? Or? Yeah, mainly the big toenails. Okay, gotcha. And let's see, you've been diabetic 10 years? So, okay, I was a teenager. You're diagnosed. And your A1c is 5%. Good for you. That's awesome. And we'll see that in a number two. much. How now any issues with burning or tangling or numbness in the feet? Before I started my chin. Okay. Okay, good. Good. Yeah, that'll that'll make a difference. Good. So that might be a lot of nice to have it. I'm very gross in motion, but on the heels especially, it gets really bad. Okay, I'll take a look. Does that ever crack open? Sometimes. Yeah, okay, does it bleed? No. No, okay. Sometimes I just need to pick and edit. You just get, oh my gosh. That's why I cranked someone. Have you had any issues with wounds or infections or anything? No. No, okay. Any issues with weakness that you're feeling is new? ankles. Can you push against me? Good. This one too. Good. And then let me know, this there's a little wire here. It doesn't hurt. I just want to know if you feel it. Very similar, except this vibrates. I just want to know if you feel the tension. Okay. It hit it harder on the side of the time, so it's probably stronger. No issues with like athlete's foot infections or anything like that. I never had a speech before. Okay. I love that. Awesome. Don't be trying to lie like that. All right. So on the good news, and it's all good news pretty much, but from a diabetic standpoint, you're doing really good. Yeah. Meaning as far as the feet are concerned, I know your A1C was 5%, which is good, but what I was getting at is you have good feeling in your feet. So that wire and that little shooting fork. So if you can't feel those things, which you can, so there's not a worry. It's good. It's likely telling us that there's some nerve damage and you could damage your foot and not know it. For example, that's where some people with diabetes get in trouble. Their feet are numb, maybe they rub a sore or a wound, they don't know because it doesn't hurt and then it gets infected and they end up in trouble. In this case, in your case, if something's harming you, you're going to feel it because you can feel those things and you're going to look down and go, oh, what's going on there? Come in and take a look. Like you had mentioned. You're doing the best thing you can is getting those sugars under, I mean, five's not even in the pre-diabetic range anymore. So good for you. That reduces the risk of you having issues with that down the road. Still not a bad idea to check over the feet every once in a while just to make sure that there's not a blister or a sore or something that you need to recognize. But everything looks really good in that standpoint. Your pulses are also really good which means that... there's blood getting down to the feet so if you ever were to get a cut or something like that they're typically going to heal. The heals, if it's okay with you, I'll send in, there's a prescription lotion or medication that's a little stronger than you'd get over the counter but it has some acid in it, not that it will burn you but it will help get rid of some of that dry skin on the heels and moisturizer. So I'll send that in. And then as far as the ingrowns. There is a procedure that can be done to remove them if it's something that's bothersome enough for you. Meaning, what we can do is cut the ingrown piece of nail out. So basically, you cut all the way down and cut that side out. And then you can put a chemical on the nails at the base. Those are where the cells that make the nail are. So you put a chemical on there, it kills those cells, it doesn't grow. grow back, at least 95% of the time it doesn't grow back. Will that qualify for something like that? So I would say yes in the sense that if you have a history of ingrown toenails that cause pain, sure. If you feel like you're able to manage it and you want to keep doing what you're doing, that's okay. We can always do it down the road if you needed to or if there are any issues. But sometimes people, it's just enough of a nuisance or a pain in the neck for them that they're like, I'd just rather have something. that don't keep dealing with this. Well that, and I just love it, but see, sugar's like more under control. Yeah. So like the sugar, you know, only being there for healing, right? Yes, so I agree with you 100% in the sense that right now, and hopefully they'll stay at this level, but your sugars are at a good level. So, you know, someone who's up over 8% or so, you'd say, oh, we definitely don't wanna, we wanna try to maximize things. But yeah, which sides I saw you point to this side This is not Okay Okay. Yeah, so the lateral side of both big toes sure so we can schedule that if you want you can do them both at the same time What's up? Yeah, so typically what you do the way we? where you get a shot here and a shot here. The toe is numb, you don't feel anything after that. We take out that side of the nail, put a chemical on there. We wrap it, but all you'll need after is a band-aid and antibiotic. There's about a 5% chance that the nail could grow back, so 95% of the time we're good and it doesn't grow back. There's about a 2% chance of infection, so we'll have a follow-up appointment just to make sure it's healing okay. I keep getting it on my feet. So there's an infection, you're right. So that ended, and to your point, that that's, you know. Really, I'm a nail tech, so I do sterilization. Yeah, so you understand the process. Yeah, yeah. Oh, we'll get you, we'll have them get it set up for you. Yeah, I think that's. I don't even know how to say it. Yeah, yeah, yeah. And I think, you know, given you're young, so I mean, you got 60 or 70 years to keep digging that side of the nail out of there, so you might want to do it. That's what you do. No, unfortunately that's the way I have to say issues. Issues. I don't know if she's there. Yeah. So it can be a pain. A pain. Yeah. Yeah. Okay. So we'll get that scheduled. Okay. Easy enough. All right. Any other questions or concerns or anything? No? No. Okay. All right. No, no, no. Yeah. Good. And that was, I think, just a function of the sugars like you were mentioning. So good for you. I mean, that's... I'm impressed. The fiber sounds good. Yeah. Yeah. and solve it you got it through your physical exam demonstrates two such order cells penis and posterior tibial pulse to both feet sounds wise and protective sensations are detected five plus five plus to both feet five five muscle strength testing for point of luncheon door suplexion bilateral ankle there is hypercaric just there is xerosis to the heels bilaterally significant fissuring ingrowing of the lateral border both create toenails without paronychia with assessment, diabetes, insert diabetic foot precautionary to onychomycosis or ingrown toenail, does have chronic issues with ingrown toenail and has been treating with home care, would like to have these permanently removed, reviewed this as acceptable to reduce the risk of infection and chronic pain, will schedule a set of convenience to xerosis with occasional fissuring to the heels, was given prescription for ammonium lactate to improve skin quality. to actually reduce the risk of faltic disfissuring and secondary bacterial infection." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Doing okay? Yes. What's nothing new hopefully? I'm gonna leave it open. This room is pretty hard. Huh? Tired? Busy? Please leave the door open. No lumps, bumps, none of the things we talked about. Appetite changes, weight loss. No. Night sweats. Okay, great. Great. Good to hear. The blood counts are back. They look good. The rest of the numbers will be back a little bit later. I will call you if I see anything. I'm hoping there's nothing to be done. David same labs telemedicine in six months one year of his physical visit. Let me check around your neck and other stuff and see if you see anything. You know we hope this thing never comes back if and when it does you know you will see other lungs, bums, stuff show up on your blood work or you'll have symptoms but so far so good looks like right? Yeah. Okay I know you were mentioning that to me who are you seeing for the process? it. Yeah, it was here. It was a classic. Ah, that's true. Did we do radiation thing? No. But yeah, yeah, yeah, yeah. Okay. Okay. Oh, that's true. You're right. So David, order a PSA. I forgot about that part of your history completely. So that was when that was, oh, that was last year. May of 2022. So let me order a PSA too. Okay, I will get those results at the end of the day. I'm hoping everything looks good. Last time we checked in August, the PSA was still low at 0.8. Let's see what it is today. Yeah. That's okay some some urologist right? Yeah, that's okay. Yeah, you're here. Okay, good Okay, so we'll see what your PSA is the iron studies are already back and that's all good too I don't see anything else of concern here John at least not what is back yet And if you're looking good, I will if there's a problem I'll call you. Otherwise, we'll let's check back Months or more is that okay? Okay, perfect. So let me just reiterate. In impression and plan follicular lymphoma stage 3, Mr. Avila is seen in the oncology clinical privacy of follicular lymphoma. His last chemotherapy was back in 2016. He's actually done well with no evidence of active or recurrent disease. Today he's just tired, which is mostly because of his... gets up early. Rather than from his malignancy, we will check where to do microgram and LDH immunoglobulin levels as SPEP. No need for any imaging scans at this time. Next number, prostate cancer patient or John had early stage prostate cancer. He was treated and finished with definitive radiation in May of 2022. Since then, he's been doing well. PSA has been stable at less than one. We'll check it again today. He follows up. of Dr. Greval from urology. Next number, borderline neutropenia. Patient continues to have borderline neutropenia with a WBC count of 4.4 ANC stable at 2.6, which has been unchanged over the last few years. No further intervention from the same. We'll order flow cytometry. Fatigue, we'll check his iron series, working B12, folate, thio, and D levels to make sure he has no deficiency. Likely, this is due to his age." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " How are you doing? Good. Happy? Yeah. Did it fix your problem? Yeah. Good. Are you having any issues with it? Not with this, no. Good. Anything I can help on? I don't know. It's kind of bizarre. I have like some pins and needles on the top of this thigh. I don't know if something like shingles can be that isolated. I don't have any rash or anything. what would cause I mean I thought that the phone in my front pocket while we were in Florida so I stopped doing that that didn't help it. Tight belt can do that. What's that? A tight belt or tight pants. I know I... Stuff like that can do it. There's this thing called Baralgia Peristaltica which is basically just a fancy term for a sensory nerve that gets pinched in the front of the head. Okay. That can be irritating. It's usually this whole front outside part of the thigh. Where it is right here? Yeah. Okay. Could be a pincher in your back. Okay. Probably just keep an eye on it. As long as you have any other concerning symptoms at this point. No, I thought, you know, it's funny that something would migrate from the right side to the left. I don't think it's hip arthritis, but I also can't recall what your left hip looked like. Let's take a look. It wasn't as poor as the right, and I don't have any pain in the hip. Well, that's more important, that you don't have pain. That's the most important thing. Are you taking anything for pain at this point? No, I mean other than the scar, I wouldn't know that I had it done for the most part. That's wonderful. Well, yeah, you do have a little hip arthritis over there. I think the bite may actually, I mean, I texted my wife and kids, I'm like, my blood pressure this morning was spot on the best it's been in years. Good. And I don't know if the bite had anything to do with it. Yeah. That's awesome. this doctor's office usually it's you know 150 over 90 once it's usually it was 117 over 77 I believe. Wonderful. Like I say it's been years since. Good. Well John this is great I mean I think your hip is coming along wonderfully. I don't foresee any major issues with this but if you have trouble with it you know how to let me know. I expect little hiccups here. as well as you're doing right now. As you approach that one year, there will be occasional aches and pains that come out with it. It's just those soft tissues and muscles and down into the back that, hey, I can do stuff again and I can push it again. That's kind of what I want for it. But the muscles and tissues around the hip will respond in kind to, I haven't made it or done anything to not push it like a normal hip would. Okay. Florida daily biking elliptical and full. I do six stations one day six stations and that's as far as strength. So, press leg extension, leg curls. So, you know, it's a whole bit. So this summer, I was thinking of going back to Genesee Country Museum for a whole time baseball. And any, I mean I haven't done anything in terms of any explosive, you know, rotational kinds of things on that back hip. It would just be, you know, a swing. Okay. and then out of the box kind of a thing. But, um. Test it a little bit. Like just in the back area. Sure. Just take that out and swing it. See how it feels. And you know, start with a pretty stiff, stiff hand, stiff swing. And then gradually look up to something that's more flexible and is more natural. And the hip will tell you if it's short, if it's a little too much. Okay. Or if you're doing something it doesn't like. Okay. But I believe we get there. Okay. Alrighty. Good. Awesome. No, I. This is what I want and expect. Yeah, no, I've said, you know, granted my age probably helped some, but. I've had no qualms whatsoever. I do it again in a heartbeat, and it's worked out really well. Wonderful. Well, let's keep that going. And again, like I said, I expect little ups and downs. Again, especially as you're pushing back the stuff you haven't done in a while. So as long as you expect that, and it's stuff that is truly little, it happens, it aches, it goes away after a day or two or an hour, a couple hours or less, that's okay. Anything you're really concerned about, let me know. Okay, okay. Our last kind of routine follow-up for this in the recovery period is at the one year mark. Okay. and just kind of say, okay, that's what it is. We'll shoot one more round of x-rays and then we'll open it up to long term follow up. In between now and then, oftentimes I will schedule people an optional appointment, but you're doing so well, I just, it'd be a waste of your time. I think I'm gonna wait now for you to come walk in for five minutes. So in that regard, that said, if you're having any trouble or any problems at any time, just give me a call. Okay, all right, we'll get you in. Otherwise, enjoy. I'd like you aboard to see me for one year, okay? Sure. All righty, good. But anything else you need, just give me a ring. Okay. Alright. Okay, I think I got everything in there for you. I think we're good to go. Yeah, you're about four months. Yeah, because we weren't back until Sunday night. Gotcha. So we flew once in January and I used the socks and the baby aspirin. In first weekend in March, I'm trying to think, I may have worn the socks up but forgot to put them on on the way back down because we had other stuff going on before we went to the airport. But that wasn't initiated, I mean I didn't know that this was happening to me. At this point you probably don't. It's never the wrong thing to be overly cautious. Sure. But being more than three months out you're probably safe. From a risk standpoint you're probably back at where you were before. And then the only other thing in between, well while we were... the first week in February I had my cleaning for my day and I was like seven days shy of the 90. Okay. So I got to the office and they were in a panic like oh didn't they give you any instructions or anything? I said well I just figured I was close enough to them. Oh no we can't do anything. They're not asking you to take anybody out. I said no. Because my wife used to have to for a murmur and my mom and so on and of course they changed their thinking on that and everything because I'm like well I'm just here for you. for cleaning I'm not getting anything true like no we're gonna be on every surface of every tooth so so anyway I'll do that on April 1st now yeah so that had to be rescheduled but otherwise tell me don't you yes on your paperwork today actually there will be some instructions that will print off that says that very okay so you can bring that okay no they were fine with because I actually I sat in their parking lot and gave a call and got a call back and so I I called them very immediately because we were only home for like four days and thought I wanted to get that rescheduled without having to call from Florida. So yeah I reassured him at that time." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The patient is a 14-year-old male who presents the clinic with his father today due to left knee pain that occurred after a fall while playing lacrosse yesterday 10-29-23 period. The patient denies having any traumatic injury and states he was simply running in a straight line when he felt a sharp pain in his knee and fell period. ACT has been able to walk without... any discomfort, but has yet to try a return to sport period. He denies having any prior knee injury or pain in the past period. Please insert a left knee x-ray series with normal findings except for the patient being skeletal, skeletonly immature. For left knee physical exam, patient has tenderness to a patient of a quadriceps tendon, MCL, and LCL. Tenderness with valgus stress or positive pain with valgus stress for assessment plan. Patient is a 14 year old male who presents a clinic with his father for new onset of left knee pain that occurred after playing lacrosse yesterday 10 slash 29 slash 23 period. X-ray imaging did not demonstrate any fracture injury period. At this time I'm not concerned for any ligamentous or meniscal tears period. Discussed with the patient, I believe he had a sprain, a strain of his knee that occurred while running. The patient does have tenderness to the quadriceps tendon, MCL and LCL. Discussed with the patient and his father that I believe his knee condition should gradually improve with the course of conservative treatment. I advise that the patient try low course of anti-inflammatories for the next 10 days, comma, rest from lacrosse. I will also send a referral for physical therapy today to work on overall knee strengthening period. I will then have the patient and his father return for additional follow up in two weeks to follow up on his progress and see if he can return to sport period. Please send a general referral for physical therapy for left knee sprained period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hello. Hello, how are you? I'm good, how are you? Good. How's it coming along? Oh, good. I feel like I have a bit of a setback though. That's okay, it happens. Um, I was going, you know, set. Going very well. And then at the end of March, I went out with a friend of mine for her birthday. And um, I don't like to sit on stools anyway. And, well, long story short, I ended up being a DD for an extremely late night. Haha. And after that my knee really bothered me, but I sat on a bar stool We ate dinner at a place and then for an extended period of time So what kind of was hurting and bothering me and well and that was like very end of March last week in March and then April 12 10th April 10th. I went to California. Well, let me tell you that's what hurts It doesn't really hurt until I try to bend it past 90 degrees. And where do you get the pain? And it's usually right here. Right in the back of the knee? Yep. Okay. Right there and right here. Okay. When I feel the pain it's right here and right here. But let me tell you when I went to California it was three flights to get there and my knees swelled up like a basketball. Yeah. And I hadn't done that in quite a while. Okay. And so like I was in the airport hobbling around and I... I went to a restaurant and they gave me ice so I put it up. So when I got home I called your nurse because I was so concerned. Now I had like a negative hohman sign and everything. There was no redness. There was no, you know, I didn't feel like there was a clot or anything. It's just, it kind of went backward to where it was when I first started working and it would swell up so much. But it really has kind of bothered me since. As far as, so I asked your nurse, I said, I don't know if. Because one thing I'm very guilty of is when I went back to work I said, oh, I'll go to the gym and do therapy on my own. Uh-huh Well, the first couple weeks were awful And so I didn't and I just I've only been to the gym three or four times since I went back to work So I said to her I don't know whether I need to push it or Not push it and she said at that point just put it up more put ice on it when I get home from work And if I rest right now does it feel better with time? Yes, okay, so But I'm I was worried that maybe I just like when my therapy stopped I stopped Doing it because I feel like I still like putting my shoes on when I go to work and I change my shoes you know, I put my shoe up here and then I Still can't okay, and I'm like is that normal? Yeah Can be it definitely can be at six months Absolutely because a lot of those little things especially that final stretching that terminal flexion It takes quite a while to get back to. That said, at this phase, it's not uncommon for people to say, the same thing happened. I was so attentive to this in the first phases of the recovery, and I just turned my attention to other stuff as I worked back into work, started traveling again, living life again. I realized now it's started to set back. Maybe what that tells us is, okay, I turned my focus back to it again. Sometimes that's as simple as just bouncing back into PT. There's a lot of people that generally want to do that at about this stage or six months. month mark. So, A, yeah it's not uncommon. It's not abnormal. Nothing seems damaged. We could check some x-rays just to be sure but I wouldn't expect that. And so I would say what you're doing is probably the right stuff and giving you a little bit of rest but yeah I agree maybe it's maybe it would help to bounce back into physical therapy for a little while for a couple of weeks and see how it goes. Yeah. Okay. They can help work on the stretching. They can help work on some TPN symptoms on the outside part of the knee. Not a bad idea. Yeah. What do you think? Cause I was like, and I was promised myself, well right now so many things are, I'm looking at leaving my job. Okay. I applied for another job, I shadowed yesterday. Well I've been at the same place for 31 years. Same hospital, I mean. So I'm gonna go back to the cancer center, I think. I haven't been offered the job yet, but. Okay. So, I've just been so, and move. I've been staying with. my mother for two years because I was going to leave and go travel nursing. Well now that kind of path is changing a little bit at least for a couple of years. So I've just been so busy and stressed and I was really worried. I thought I'd gain more. I stayed away from the scale for like a month because I knew but at least it was only three or four pounds and not more than I thought. I don't know. I mean do you think I need to go? to like structured physical therapy. Yeah but I don't think you need to go like three times a week. Okay. Okay good because I just don't know what I can do with work you know what I mean? And they can work around it. Okay. I mean what I would recommend is just get a good regimented home program that you can do diligently every day. Work with a therapist and then follow up with them like every couple of weeks. Okay. Make sure they can update it for you. Okay. Um. And I have this. the spot it feels like there's glass in there where right there well it feels kind of deep but man and I didn't notice it but I was rubbing my scar with vitamin E right about well that I don't have like maybe a stitch it could be that and I'm like sure but I mean it or just right there it just went over it it could be a little scar tissue in the bursa in that pre-patellar bursa Okay, so do you just put in an order? for PT? Yep. Okay. But you're going to be doing it afar so what I'm going to do is print out. Okay. Have that printed out. Okay. All right. That's in. That's good. Are you taking anything right now for pain? I'm still taking probably at least one dose of Advil and one dose of Tylenol a day. Sometimes too. but definitely one. All right so we'll see the x-ray show with the trapezius and physical therapy now are you still generally feeling better than before surgery? Yes the the everyday normal pain is gone and the one thing and I love doing it every day because it makes me when I do stress tests I have to let it stress test I have to we have an old stretcher so you got to pump it up okay now that used to kill me I couldn't do it I had to do it with my other foot and I can do that I can pump up that stretcher even with a big ol heavy person on it and it doesn't hurt at all okay it's mainly just this flexion that that flexion going and I just picked up my motorcycle from the shop okay and rode it for the first time and getting on and off it was still rough yeah Give it some time. It'll come. It'll come. This is why New York question takes a whole year. Okay. Because it just takes a whole year. And you told me that. I guess I just need to hear it again. It takes a whole year and that's what half of these visits are is reassuring people, no it's coming along. It's coming along. It takes time. It takes time. It truly takes a whole year for your body to just accommodate to it. And again, think about saying this like three months ago. Right. Oh, I'm checking on my motorcycle or I travel across the country or I did this, I did that stuff you wouldn't have even thought about. but you were having the same symptoms. The issue isn't that you're having the same symptoms, it's that you're gradually, where you're getting better is you're doing more and more and more. And that's gonna push the symptoms, but that's because you're telling that knee, hey, you gotta tolerate this. And it's like, I'm not ready, but I'm gonna push you. You know, it doesn't have to be ready. I mean, as long as it's not crippling you, you can push into it a little bit. It's like weight training. And I guess that's what I needed. I didn't wanna do something that was going to hurt it. No, it'd take a lot. I mean, you can use your symptoms to gauge ya, but it's like the way I think about it is. It's like weightlifting in the gym. I wanna get to a point of being able to bench 200 pounds. I can't start with 200 pounds. And when I start with 100, and then I slowly work my way up, I have to push it past what I can comfortably do, otherwise I'll never actually go further. And there will be some days where I can push really high, and there'll be some days even afterwards I can't quite get there. And it's frustrating, because it's like, well, I just did this. Same kind of thing. It's just the biology. Notice that I still don't seem to be able to do. is go downstairs. Foot over foot. PT will help. Yeah. This is the kind of thing people get back, all these things are the kinds of things people jump back into PT for a little while for at six months. Yeah. Okay. My friend that you did both her knees, she's in Santorini, Greece going up and down and everything. So I'm like. She's a lot further ahead. I'm hoping. A lot further ahead. You'll get there. You'll get there. All right. So sit here. You can go ahead and get changed if you want. Okay." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " And just something didn't feel right. So I ended up going to Urgent Care and they did the x-rays and nothing broke and will give you a referral to orthopedics and I thought, well, maybe the bumps will go away. They haven't. The pain is mostly subsided except when I wear shoes that are almost all my shoes, push right on this spot. So you have pain on the outside of your ankle with bumps that have been there. since I noticed them after I twisted my ankle or something. Honestly, it felt like I sprained my ankle. I was twinging some things around the house. How long ago was that? Monday before Thanksgiving. Okay. And so I've had something that happened when I was hiking this summer where my foot was incredibly sore right up in here. And that would come and go. I don't know if it's related, but I... I have to mention it because it's bothering me now. Whereas the ankle is only bothering me if I put on shoes that push against these bumps. So it does feel, I did ice, ibuprofen, elevation, and the, I can still feel some tightness when I rotate my ankle, but I feel like if it wasn't spring, that's resolving. But the outside of your foot bothers you as well, and that's been bothering you for a longer period of time. It has been. off and on again I first noticed it on after a long hike probably in June let's see here sure so that's the spot right there so on examination you have a large bump that's likely firm slightly mobile Is it tender? It's, yeah, it's tender underneath, not on the outside. So this is all on the lateral aspect of his ankle. And I honestly don't know if it was there before. He has very good ankle range of motion. The pain here in your foot is over in this area? Yeah, right about there, right about there. Yep, right where he is. Dorsolateral foot tenderness. Otherwise, goodaby. Pulses, sensation okay, push up, down, bring on up, and good motor function. So you had an ankle sprain and then you noted this bump. Yeah. Okay. And if I hadn't noticed the bumps I probably wouldn't have gone to urgent care. I had difficulty driving. Just the flexing was... troublesome and that's all gone. It did make it difficult to wrap the ankle because that was just putting in agony for those few days. So x rays of his right foot. Personally reviewed and interpreted. Show an intact ankle mortis. No evidence of fracture. He does have a cavus foot. There's no obvious midfoot arthritis or fractures. Other What all that means, I'm just talking to the machine here. It actually makes its AI technology and all this miscellaneous conversation we have, it gets rid of. And it does a really good job of interpreting what we're going to, putting it into what's like a note. That's cool. Yeah. So, but you don't have any arthritis out there, which you do have though is pretty high arch foot. And sometimes that means you're just putting too much pressure on the outside of your foot. Oh, okay. And your ankle, which you feel like is occasionally unstable, could be because of, could very well be. So let me see your ankle here. Sure. So back to the examination of the ankle. There may be some slight, yeah, there may be some slight instability to varus stressing. So this, so I do, you've rolled this ankle a bunch. before. I think your ankle ligaments are a little loose. I think you tend to put more pressure on the outside of your foot, which causes this. And this is a ganglion cyst, I think, just because you've injured your foot. So I think that's what we call a ganglion cyst there. That's actually what the person who examined me at urgent care thought it might be. Yeah. And I think it's from ganglion cysts are cysts that come from synovial fluid and they you know joint fluid or tendon injury okay and they can build up in there and cause that but I think you have some chronic ligament injury okay that's a ganglion cyst and then you have you know your foot I think you have some little or you don't really have arthritis but I think you overload the outside of your foot how long is the outside of your foot been bothering you I would say since about June off and on but it may have done that before I I went through plantar fasciitis years ago. I ended up doing insoles on all my shoes. I do prefer a stiffer soled shoe. I mean, how well do you tolerate this ankle rolling on you? In what's- I mean, how often does it happen? How often does it roll? Not often, but I do like to run. If I lost like 20 pounds, probably be a lot nicer on my ankles here. But- And if it starts to bother me, I'll lay off running for a few days or you know, I'll just I'll just take it easy I do like to cycle a lot Usually doesn't bother me when I'm cycling. Okay So treat so some of the treatment options are one, you know You could we could try it with some PT and see if they can help you work on some exercises to strengthen your ankle Okay, and that's more for the rolling Yeah, we could get you an insert in your shoe to try to build it up a little bit on the outside Okay So maybe you won't put so much pressure towards the outside, which also maybe keep you from rolling your ankle. And for the ganglion cyst, I try to put a needle in it today and drain it. Sometimes they'll come back though because the irritation doesn't go away, but sometimes they'll come back smaller or they won't come back. So it's likely that was there and I just didn't notice it? No, it might've been because you injured your ankle and fluid build up and it actually gets out somewhere. It gets out through this almost little balloon thing and then it gets trapped. in there. Okay. But we could try it you know the one good thing if we put a needle in it today and then it tells us it's a ganglion cyst. Okay. And then we don't have to worry about it and then we could try you know some PT and some inserts and see if that can get you because the other options I mean there's surgical options you know one of the surgical option is to solve your ankle ligaments and make them tighter you know but it doesn't sound like it's that much of a problem. Okay. Where you tell me maybe it is that much. No and you know I try to stay active and And when things hurt, I take a break. I have a slight meniscus tear, and that was the advice. They were like, if you don't want surgery, when things hurt, stop doing that. All right, so I think what we'll do is we'll aspirate your cyst today, and that will give us a diagnosis of that, and then we'll put you in a script for PT and some inserts for your shoes. All right, sounds good. Thank you. Ah, I'm relieved." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " How are we doing Mary since we last saw you? Same house, yeah. Which is what? Good, bad, stable? You know, on your scans, for the most part, at least the CT part of it, you know, we are not seeing much going on on the liver. They keep talking about just that spot which... is growing but nothing else happening. You know so like before this was about three and a half centimeters now it's 3.7 so this area is is that area is growing yeah I mean on the liver frankly we are not seeing much going on the good thing is or the other thing is on when we look at your blood work also remember it's a little hard to tell. your disease we've been usually focusing on this and the liver. On the liver part of it things are actually pretty decent. Your bilirubin, the jaundice remember which is very high which is a reflection of your disease has been actually very stable. The other measure of your disease the alkaline phosphate just to give you an idea this is basically again this is how much how it's a surrogate for how much disease you had in a liver And this is basically earlier in this year when it was very high when I was like, oh, I think we are in trouble In the summer, this is around April Since then it's been actually much better same thing with the jaundice Okay, so this is the same thing which is going on so it's not close to normal But it's as good as it can be. Okay I think I don't know if we can do anything about this The easiest would be all this to do surgery. I know we had you see the surgeon, but they weren't too keen on doing anything Correct. You saw dr. Narahari at one point or you never saw Yeah Yeah, that's true. We did do tri-radiation. I mean, I don't know how many times have we done radiation once or twice? twice already I mean, that's the only spot that I'm seeing Mary. I'm not seeing anything else which is you know I feel in a way remarkable I this is not something I expected this disease to do as with these with this medicine but somehow you're you're chugging along pretty fine okay so so the only thing that you're we are seeing is this fatigue of yours which I understand the more chemo we give you the more fatigue will happen but you're not super anemic what about the stingling numbness anything? Um, stairs just a little bit though. But not a whole lot? No, but um, my balance is not good. Balance is not good? David when was the last MRI we did for her? I think it has been weeks. I think it was, yeah. I think it was a year ago. You know, so let me just confirm, you know, obviously what we worry about Mary is on your scans things look good. I am. I'm very worried. Just not worried. I'm worried about. the brain okay I thought we did that MRI in August let me order one again by the time you order it will be it'll be December when's her pets can they would do? and 12 so October November December January so let's order for January and then I can see her then okay so we'll probably do it around here and then I can see her there in a month the we can let her go let's see if she can see same on here on 11 12 28. If not we can just leave it be what you were saying. No I can't think so I mean you know that's why I'm checking the MRI just to be super sure the last few times I've not seen anything I mean your electrolytes are slightly off like a potassium calcium but there's nothing really bad here okay. So, I mean, all I can say is there is that growth in that side lesion. We can see when was the last time we did fatigue panel for her. It's actually due now. Let's go ahead and order one. At this point, if we, they were over here, they would see if you want to move it here. At this point, let's see. I don't know I can ask the radiation doctor again if there's any point in doing zapping you again or not I just don't know if they will do it you know the whole issue here is if that's the only spot everything else in the liver especially looks good I don't know if anything else will be better is it bleeding okay I mean I can try have you see the surgeon again but with your insurance it's a little challenging I don't know what they will let us do insurance wise you have no option are you not two years into this that you should get Medicare what are they saying when did we diagnose you it's been two years yeah so usually when you have cancer and it's been more than two years you get Medicare they didn't say anything talk to your social worker yeah because you are technically on lifetime disability right yeah basically for like we know for dialysis and other patients it's like two years they get Medicare just because if it does then it makes my life a little easier because the surgeons I know there's insurances no one is going to see unless we send you to the ER and I don't want to send you to the ER just because of this I can have you talk to the radiation doctor again when was the last time you did radiation on it I can see if they'll agree to that. Okay? But as I said, so far so good. Let's get a copy of this and then I'll check back with you in two weeks. You keep up with your routine. We'll check back with you again with a scan in January. I will see if I can have you see my nurse practitioner. Okay? You're good to go. I'm just gonna work on your. Okay, can we just go upstairs? Mary had a CT scan of the abdomen pelvis in HbA, please add Mary had the CT abdomen pelvis in 11-21-23 which shows enlarging lesion in the left flank measuring 3.7 times 2 versus 3.2 times 1.7 before liver densities are relatively stable. Maybe there's one lesion which appears to be new in the left liver. moderate intrahepatic and extrapatic biliary dilatation due to prior cholecystectomy, stable sclerosis of the vertebral bodies from metastatic disease. Continue with assessment plan or impression and plan. Metastatic melanoma, BRAF mutant, Mary E.C. dermatology for metastatic melanoma. She continues on carbotaxol. Fortunately, she's actually doing relatively well. Gage's complaint has been fatigue, which is not unexpected. Her CT of the abdomen does not show a significant change disease in her liver. Her skin lesion continues to enlarge. Unfortunately, that is, she's not been able to get surgery on the same. We will try and see if we can have her see the surgeon. I think she will continue on the same treatment given her liver function is otherwise okay and she has no other areas of distant disease. She's been complaining some non-specific dizziness and headaches, ulcerative and MRF of the brain again. Last one was done in August of 2017. 23. Next paragraph in case she has disease progression in the future we will consider we can consider putting back on immunotherapy since it's been close to more than six months since the last immunotherapy treatment. Next PET scan is due in January 2023 at which time I'll take a look at her." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hi! Hello, hello! Good afternoon! Maria, right? Yes! How are you feeling today, Maria? I'm feeling good, but I'm just coming here to... concern about my right ear. So you think your neck or this area? This right here. And I'm going to, you know, where's my ear? That's a salivate line. And the other area? The other one it's... See? You think it's asymmetric, huh? Yeah. Now go straight with me. Look at me straight. It's just a little bit more swollen on the left side. Yeah, this one is smaller and this one is big. Are you dry? A little bit. It's dry, my salivary gland. So, like, I went to ENT, and then they do me a biopsy, and also I have a CT scan, and everything's okay. Well, I just kind of worried because my mom, she passed away from lymphoma cancer in her leg. The ENT, Dr. Sheff, there's nothing not to worry? The doctor told me there's nothing, all the results are all good. But I'm just curious why it's getting big. When did you notice that? I noticed this a long time ago because my coworker told me that it's my face, right here, my jaw is getting bigger. Who told you that? My coworker. My coworker, hey, you can leave it surely on that side. Yeah, even my friend told me. But I noticed that when I go work out, my electrical and I got headache but you know I got migraine and I have my sinusitis, my chronic sinusitis and also I have my allergy. Do you feel uncomfortable in your mouth or that feels normal? My mouth is comfortable. Do you feel a dry mouth? Sometimes. Like when I'm swallowing salami I don't have nothing. Do you have pain? meaning your jaw? My jaw, it's a little bit, I don't know, it's like a sharp, it's rubbing me. And you're a dental hygienist, right? I'm a dental, I work in dental, so I... I was going to suggest you need to go to dental exam, I see there's nothing with your gums. Did you see the dentist? I did. And there's nothing in your gums, or your tooth? No, the only thing is... Do they take edge-wires? I do, I don't have my panoramic, everything's normal, and I just have my extraction for my teeth because they're doing impact. I even eat some bread and it's just rupture. So the only things I notice this like sometimes like today it's cold a little bit and I compare like it's sharp right here. It bothers you a little bit more. It's wanting like rain. I see in your records an ultrasound that was completely normal. You said there is also a catch-can? I didn't really embrace everything's normal. They said I have a... They said I have a... I just... I just... That's why I've been... I got choke on because that one in the very place. But anyway... What is it? I just googled this and forgot what the doctor telling me. I cannot remember. I got a salivary gland enlarged. See? I just keep go-go all the time, and I just kind of worried. You know, I don't want to be like my mom, My mom, she has lymphoma cancer and it only takes one month and she just pass away. And of course I just worry. Parotid gland, that's the one I have, parotid gland enlarged. So I notice that because I'm grinding when I sleep, right, but I'm wearing my nightguard since I know. So... Let me see here. Let me see. Have you been diagnosed with anything else in the past? No. No diabetes? No. No arthritis? No heart disease? No. I... Well, I want to... This is my result for... They take me to the... They take me to the specialty after A&T, right? This is the one I have for... They send me to... Rheumatology. Why did they send you to Rheumatology? I think a couple months ago. Why did they send you there? Well, to make sure everything, when the A&P sent me to Rheumatology to make sure I'm okay. So the only things they know is that I have like, probably for my bones, but like a little bit of rheumatism in my neck. So this is my result here. So that's why I think that's the reason. Do you take any medications? I am taking some, right now I'm taking some, uh, Serpic and Cholesterol, uh, Lopitor for 10 milligram, I think. Okay, take a deep breath. Okay, again. Deep breath. Out. And again. Another deep breath. Okay. I want to go from back here, feel some, some notes in this area right there. And then I want to feel your neck. It's very, very close to the same, but yeah, it's just a little bit swelling here. It's not completely abnormal. Nobody's completely symmetric. And yes, I can see that your coworker told you that maybe there's a bit of swelling here. Is this swelling getting worse? Yeah, I noticed that it's swelling a little bit, but when I touch right here, I can feel like hard. Yeah, and of course you have a CT scan all normal, you have an ultrasound all normal, so we need to trust that, right? Do you have any swelling in your legs? No, I don't have swelling in my legs. Okay, have a seat here, we can talk a little bit more. Are you married? Yes. Kids? I have one sister, Tito. And you smoke or drink? Never drink, never smoke. Very good. My daughter is not practicing any. So I definitely, I agree that if you check the right side with the left side, the left side has maybe 2-3% more volume. When I feel with my hands, I don't feel anything bad. Cancer, feels like if you have glass or rope under the skin like this. Or you, it feels the same on both sides. It feels rubbery, it feels soft. Because it will feel like your knee, you feel more like soft. I would make sure that there is nothing in the dental area of things. You already went over there, you work over there, and there is nothing dental. The surgery already looked at me, like two surgery doctors. When I was in my office, I was planning to order either an MRI or a CAT scan. But you already don't know for sure, and a CAT scan. So if I was going to do something, it's like I would like to see you again in three months, and if this looks any different or the same I can do an MRI but MRI is going to show the same normal. I can make you go all the way to ENT oncology which is at UCSD but I'm not going to want to do anything to you. Nobody's going to want to hurt you with the biopsy. You don't have any relevant symptoms about the function of the salivary gland. It is normal for people to be a little bit asymmetric. Maybe now that you know you've just paid too much attention on it and you're obsessed with it and that way you work but there's nothing to worry about. Everybody is a little bit asymmetric. Maybe you look at your legs and you measure one might be a little bigger than the other. That doesn't mean that there is cancer. Something that I think is very important for you to know is the following. One, lymphoma is not genetic. Two, having lymphoma at age 80 is like garden variety anything because at age 80, anybody can develop lymphoma. And lymphoma is not genetic. And lymphoma is a disease of growing lymph nodes. Now lymphoma, we actually cure like 90% of people. Maybe your mother because she was 80, maybe the subtype of lymphoma she had. But this is not lymphoma. Because you are like significantly younger than your mother. So I know that you worry because you have lymphoma and she didn't do well. But I don't even know why. Maybe you bring me a breakfast if you want. Because lymphoma we can treat and make people live 20 years or we cure them. So something happened connected to the lymphoma. But it's not genetic, has nothing to do with salivary gland. Yes, what is enlarged is not the lymph node, it's the salivary gland. But I don't think it's malignant. So maybe I'll see you again in three months. If we're still worried, we'll get an MRI done. But I don't think you should worry. You are wasting your time being worried because being worried takes away your well-being, right? Yeah. No reason to be worried. The only thing I'm worried, because I know before my face is a little bit smaller and now everybody thinks that my face is getting big right here. Sometimes when I touch right here, I don't know if that's normal how I touch, like how you feel it. See like right here, I touch right here, I can feel it. And it's true. It's a little bit larger over there. But that doesn't mean, I can see it. You are right. It's a little bit bigger than the other side, definitely. It's maybe 3-5%, but it's not cancer. It is not. So do you think that I got infection or what? I don't think I have infection. I think it's just normal. So I've been taking sometimes because you know ibuprofen it's good for inflammation right and I take that sometimes but the only things I cannot tolerate because when I'm taking I have a stomach upset even though I'm drinking some milk or either I eat before I taking some medication so I just kind of worried I thought the dog and I know my face is not like that and I mean time like I would be today is bigger because when I go to work it's cold like I live at 5.30 in the morning so I just and I've been searching a lot all the time that's what I do I keep searching I said man where this this come from yeah the best I can tell you is like you don't have lymphoma you don't have cancer sometimes there is asymmetry to give an example I'm sure you have friends that maybe one breast is a little bigger than the other but they both are normal and the mammogram and MRI is normal but that friend of yours thinks she has cancer because one is bigger than the other she's gonna drive herself crazy it's normal to have one breast bigger than the other and it is what it is. How about right here though? Do you look right here? This one right here? Yeah I agree with you it's a little bit asymmetric but you don't have cancer. Okay. Oh my god. It's not cancer. That's why my vital signs go up this time because I never sleep. I said okay my god. It's not cancer. It's not lymphoma. Now, I'm going to see you again in March. And you're going to do blood work and I'm going to check things for lymphoma and I'm going to see you again. If there is anything change, a very good memory, I may order an MRI, but that would be ultrasound, CAT scan, an MRI showing normal. So this is a point in time that we need to believe in the reality and not your emotional fear because you don't have cancer. Okay. I just kind of worry like last night I kind of I wake up 12 and I cannot sleep so when I take my vital signs in my work I said oh my god my vital signs go up because I've been worried too much. I understand why you're worried this is why in three months we're gonna repeat studies and see you again but you need to relax you can't be worried about something that is not alright. Yeah I know. It's not cancer you already held it for the third time exam doesn't show it. Cats can't, forget what I say I'm just a human being. The cats can't show anything. You need to believe what the CAT scan shows, right? I know. Just kind of worried. Just all these people said, why you, why you, your jaw is getting bigger. Like, like the... Make sure that the vent is also find anything there. And I think that jaw is going to be bigger than the other side forever. But it's not cancer. Yeah. Well, I just, I just curious though, why my face is not like this before. Like I got very tiny, but this one it's getting big. So I keep I'm getting my ear right here by my jaw under the ear. If I get an MRI in March, it will describe the same thing that I will see. But it's not going to show malignancy. All right? Make sure your health in your jaw is very, very good there. That's it. For my jaw? Make sure that your mandible. Mandibular. Your lower mandible has no gum problem, no bone disease. If the dentist says your health is perfect, don't worry about this. Yeah. Every day when I see the oral surgery dog, I always ask him, this dog can you look at my... stop touching it, it's not cast, it's nothing. Two months ago he came back, there was nothing in there. So stop grabbing in there, stop paying attention, believe the cast can be really off the sun, believe the doctors, there's nothing in there. Stop squeezing it, stop trying to make it go away, you're gonna be a little bit bigger there forever. Leave it alone until I see you again. Because if you keep holding like that all day long, you're making it bigger. I know, I just... You understand? Yeah, thank you, but... That's why when I worked out, I said, I feel like this one is like different like this rubbing me. It's nothing. What? In March? I'm going to do the same thing. Okay, thank you so much. Okay, thank you now. So I'm good to go? Yeah, make a promise to see me in March. But also don't work, okay? For March? Okay. Then wait before you see me. Okay. Okay, thank you so much. I'm going to do blood work in March and then a week later to change. So I'm going to show you how to install the new USB-C port. I'm going to show you how to install the USB cable. I'm going to use a little bit of water. I I'm sorry. I'm sorry. I don't hear you, is your microphone on? Let me go for my volume, see if I can hear you better. Okay, go ahead and talk. Okay, can you hear me now? Now I can hear you. Can you hear me and you can see me? Yes, I can. Very good. Michelle Mafra, right? Yes, you are correct. Very good. You know the reason why I wanted to see is because I talked to Dr. Flores this morning. He asked me to make sure that you are okay. I wanted also a little bit to review what happened with my office. It was yesterday that you were very upset with the day before? The day before. What happened? It was probably, it was on Monday actually. Monday, and what happened? Well basically, first issue that has been happening to me On the previous Monday, I've called the office to request some renewals on my medication. One is Keppra, which is an anti-seizure medication. And the other one is Ativan. And after I request the medication, I of course, the other girls say, oh, we're going to send it right away. Then I call on Tuesday morning, I call the pharmacy. and they didn't receive. So I call you guys back, oh no we're gonna send it, we're gonna send it. Well it's been a full week process. Only Thursday I was able to have the Keppra, which I stayed without Keppra antiseizure medication for two days. And they were able to send the Keppra in to my pharmacy. And I received the Keppra that day, which was great, but they didn't send the other my anti-anxiety medication because they said, oh, it needs doctor approval. And I'm like, you know, it's been requested since Monday. How come the doctor doesn't approve until Friday? You know, so I've been fighting the whole week. Like I call NICE the first time, I call NICE the second time, I call NICE the third time. I have the pharmacy contact the guys and request and yet things just don't move. So they fall through the cracks and I don't get what I need. So as a result I stayed more than a week plus the weekend without anti-anxiety medication because no one did their job and sent it out for me. And then on Monday and this is, to be honest with you, I'm going through another stress because Medi-Cal had an error and they denied my policy as of November 30th. So I've been escalating with them so I didn't lose my my medical which got instated on the 4th so I have my medical back but since October I've been working with them to maintain my medical because I've been at risk of losing my medical so that's already something that is aggravating me and creating a lot of anxiety and then I call medical I wake up at 6.30 a.m. I drop my little girl in school and I've been on the line with medical while my cases standing, begging them to pay for my Quest lab tests because I already had scheduled way in advance an appointment on Monday because they always like for me to be on Monday, really close to my treatment, which is on Wednesday. And I arrived to the lab on Quest and basically they told me, oh, your order has expired and that it was only one girl working on The room is full of stand by people. Okay, and I told her, I said, I beg you. She's like, are you gonna lose your appointment because we can't wait for you to get it. I said, please, I beg you. I'm gonna call the office right now and I'm gonna text you right now. She's like, stay on room number one and make your phone calls and I'm gonna take people in and I'll try my best to detroy your blood as soon as you finish, you know. I get to the office, I talk to a girl named Christo, and I told her, we have the lab, the order has expired, would you please fax another order to the lab? Gave her the fax number, and she's like, oh yeah, I'm gonna send it right away, it's gonna take about 10 minutes maximum. They send the order in, okay, and I go in all excited, and I tell the girl, I finally got the order, can you please squeeze me in? It will be amazing if you squeeze me in, because my treatment and that's the only chance I have to get the results from you guys. And she squeezes me in, but she takes my blood from this arm, telling me that my arm already is building a lot of scar tissue and that I'm lucky that my vein hasn't bursted yet, okay? And when she draws my blood, she draws just one vial. And then I'm like, well, that's really strange because normally every time I come here, you guys pull out three to four bios and it's a lot of other tests. And I'm like, can you look at my test order and see if everything is in there because I don't think one bio is enough. And then she goes and she's like, oh yeah, they send an incomplete order. And then she's like, you know, independently if they send it again or not, we cannot see you today because I'm so overwhelmed. I have too many people, as you can see, the office, we need some staff. And then I'm like, okay, I called the Ensenada's office, they don't have any time. I called the VISTA office, they don't have any time. And I called the girl, and I said, you know what? You guys are playing a game with me, because I've been fighting with Medi-Cal to get everything done and properly, and everything goes smooth so I can do this treatment on Wednesday. You know what I mean? Now you guys sent me an incomplete order. You know what I mean? The lady on Medi-Cal told me they should have gone into your file, consent the order, you know what I mean? And then I lost it. And then I yelled on the phone and I said, you know what? I'm gonna die right there, right now, hyperventilating, you know what I mean? Because it's the only way to get things done in this office, you know what I mean? And you guys are gonna draw my blood independently from my insurance covers or not, because I'm not gonna miss the treatment that I fought three months to medical to maintain the treatment for me. Okay. And I drove there like hyperventilating. Like I literally was sweating profusely. You know what I mean? And I couldn't stop yelling. It's like I had panic attack because I felt like these people I never felt so much disregard for my life in my life, you know, and it's like I'm fighting for my life. And basically that's what happened. The girls luckily were able to accommodate the blood test for me. And then I said, I'm waiting on this medication. I was shaking. I'm like, I'm without my anxiety medication for over 10 days now because you guys can't do your job. Why are things falling to the cracks? I should be focusing on nutrition, taking care of my seven year old girl, my stretches, therapy, and by the way, I'm missing therapy that I'm taking out of my pocket to be here right now, because I have a therapist in Brazil that is helping me to cope with the issues of having terminal cancer. So you have a psychotherapist or a psychiatrist? It's just a therapist. Yeah, just a therapist, and it's fairly new. I had four sessions with him, and I'm texting him saying, I'm gonna miss the session, I'm here, you know, trying to get the blood test and everything for my treatment. So it's just like that level of aggravation, like if I could call one time and make sure that things are gonna get fixed to the pharmacy, it would be great. But every month, I have several medications, so I'm calling you guys constantly and having to double check, triple check, call the pharmacy. The pharmacy helps me try to get to you guys. And nothing happens unless I throw a fit. I throw a fit, then things work out. And then they called the cops on me and all this big word deal and I told the cops, I said, you know what? And the cops told me, like, you are fighting for your life. You are a strong woman. You shouldn't go through this. They gave me a ton of resources so I can find help, therapy, for restrictions in case I don't get from you guys. You know what? You shouldn't be treated this way. You know what I mean? You have no problem. You know what I mean? They saw that my frustration was real. Did you tell them why they called the cops? Huh? Did they tell them the cops? What did they call the cops? Yeah, because when I yelled on the phone and I was aggravated, I told them, you know, you guys can call the security because they called the security once for You know what I mean? Because I was having problem with EDD and there was a girl there that would never send the papers to EDD. You know what I mean? And I got a little agitated in the front office and they're like, how are we gonna call the security? And I said, call the security, call the cops, call the freaking Pope. You know what I mean? I'm gonna get this done, you guys gonna get this done because of your guys in my life. You know what I mean? And I don't care. You know what I mean? I'm a well-educated woman. I have a master's degree. I'm an MBA, I know administration, I ran businesses, you know what I mean? And I can completely understand that there are a lot of newbies all the time. Every time I come, there's somebody else new in the front desk or something. But this is people's lives. This is literally people's lives. And you can't jeopardize and add additional stress in a situation that is already stressful. I am over the top disappointed. And that's what I told Marty. I said, you know, I'm the type of person that, you know, I fight for my rights. And, you know, but don't keep me sending like to give you guys review because right now, you know what I mean? I prefer not to feel nothing. You know, I don't want to feel, I don't want to give you guys any bad reputation on the content. You know what I mean? I love the doctors. Dr. Flores saw how I was in the hospital and how much I have progressed, so I would hate to abandon a doctor that I like so much. However, if this administration issues keep on happening, and I mean, it's not like, there are people that are in worse condition than I am, I have brain cancer, I can have issues and not have good memory at any time with some sort of inflammation that happens in my brain, and how can I rely on if you guys are doing, Okay. When I have a ton on my plate with a seven year old, dropping off from school, picking her up at three, like right now to make a phone call, I have to show it to someone to pick up my daughter for me. You see, my life is not as simple. It's very delicate. And this year has been a rough year for me. But what I expect is everybody, if they do their job, jobs, things won't fall to the cracks and then I can trust the treatment that I am actually receiving right now. But if I have to triple check, quadruple check, triple check, don't expect me to be nice on the fifth phone call. You know what I mean? Trying to get the same thing, one simple fact to be sent to a pharmacy, for example. And literally this is where I stand right now. I love everybody there, even the people that, Gina, sometimes I'm irritated with her, but I love her, I love Marty, I love everybody that takes care of me, but I just feel there is some sort of disorganization there that are preventing things from running smoothly. And that is not beneficial for patients that really can't be receiving this amount of stress cortisone healings and you know we should be focusing on all the healing possibilities you know I could be in a compulture I could be you know all this time wasted on the bureaucracy of it is driving me bananas you know. So Michel I'm gonna talk about two things one your situation I'm very happy the way Dr. Flores been treating you you did great treatment practically the last scan everything looked great. You're taking maintenance treatment that is very, very good with immunotherapy and a single drug, a link that we call it Premetrex. You're doing great. I noticed that your last scan was done at the end of August. So I want to do one now to see exactly that you're still in a very good place. I think it's time to do another scan. I think the brain, you're doing fantastic. I just want to repeat the MRI to make sure there's nothing in the brain. And I believe that if everything looks good, if everything who looks good will continue the same treatment that Dr. Flores gave you. Now, in regards to all these other things that make you upset, I want to let you know, number one, I am sorry that you suffer stress through this because you have cancer, you have your family, you have to take care of everything, and it's very stressful. So I apologize that my office made you suffer and caused this severe anxiety. That being said, this is the second time that the office gets very stressed with your reaction. I understand why you are very upset. I think anybody would be upset, but not to that level. What happened yesterday is that my staff had to go out on leave of absence for three weeks for the level of communication you have with her. And of course, this is something that we have to deal with. You told my staff that you were going to kill her coming to the office. And this is why they call security, because she heard that you were going to kill her. She got all scared because you were so mad. And you told her you were going to kill her, right? Because you were so upset. Anyway, but I understand why you got upset and I understand that you need to get your prescription, but this is the thing. I can't fix getting this sativan perfectly right for you. We're not anxiety doctors. We're not the psychiatrists. I would like you to connect with your therapist and your primary care doctor to see who can take over the treatment of this level of anxiety and getting upset. Because I know that it affects your not just here with us, it may affect other areas of your life. I noticed that you are taking an anxiety drug called Lexapro. Are you still on Lexapro? No. They need to give you something that can control this in a better way other than Ativan. Of course, when you are on Ativan and also the Ativan is not there, you get very anxious, right? And I think this office, we have got to this level of size that clearly we're not serving you well for your needs. So number one, I would like to talk primary care physician about this, how we can help you never missing your drugs, how we can get you to better drugs than Ativan. Ativan is not the right drug. Ativan should be only needed when you are not well and they should be the drugs that control you all the time. And clearly I would like to talk to your primary care doctor about which office can serve you better for your well-being because maybe this office is not it. But who's your primary care doctor? Who do I call? Her name is Gabriella. Let me find her last name. Is that the PA? Gabriella Sutton? Yeah. She's on True Care on Ocean Side Boulevard in Ocean Side. And her name is Gabriella. I keep forgetting her last name, you know, partially because, you know, my brain doesn't function really well. But her name is Gabriella, and she is in True Care. Okay. Let me see if I can find her name here. Yeah. Gabriela. And I talked to Doctor Doctor Flores earlier. I pulled her out of her conference because she's your doctor and I just wanted to make sure that that she's aware that I was going to see you and call you. Uh huh. And I know that I saw the name Gabriela somewhere. So, what's gonna happen is that I'm gonna talk to them, I'm gonna ask them for their health to make sure that you always have the Ativan. I think they need to put on some more of the anxiolytic in addition to Ativan. And then we'll talk to them about what is the best way to care for you. I'm very happy that you are doing well. We're responsible for your cancer. So we're getting a CAT scan. We're getting an MRI. You're going to stay on treatment in my office. Like the next time you get treatment is going to be December 27. But then after that treatment on December 27, when you come to get your immunotherapy, and that is in maintenance chemotherapy drug, then the primary care doctor will decide how is best to care for you. But I don't want my staff to have to be threatened and afraid. And more importantly, I want your well-being because I understand how you felt and you don't need to feel this way. But my office doesn't have to feel threatened either way. So I'm going to talk to your primary care office and see how we can fix that. our care, I want you to let us know 10 days before you run out of a drug, but more importantly, call TrueCare because maybe TrueCare will do a better job than my office to get you these drugs. Okay? Okay. And another thing is when you say I am receiving chemo and immunotherapy, correct? Those are the two treatments that I'm receiving currently, correct? Correct. And yesterday I was talking to the girl who was helping me with the chemo and immuno. And she said that the chemo has changed, that I initially had one type of chemotherapy that was a little bit more aggressive. And then it was moved to a chemotherapy that is a little bit more, less aggressive. Does that sound familiar to you? Yeah. So from day one, you've been on the same immunotherapy. It's called checkpoint immunotherapy. However, the chemotherapy after six treatments, we reduce it to what we call maintenance. So you are taking two drugs, carboplatin and a drug called adimptan, two drugs. But after six treatments and with a very good results, we simplify the treatment to only give you one drug instead of two. So we're taking just one drug. It's the same drug as always, but it's a non-toxic drug. It's very well tolerated. That's why we keep it for maintenance for one year. So what she meant is exactly what I'm saying. telling you, yes, the chemotherapy change from two drugs to just one drug of chemotherapy and that is significantly easier for you. Okay. And so there is no real difference between the two, right? You guys didn't downgrade the... We went from two drugs to one drug. And what we do is the National Cancer Institute guidance. By this National Cancer Institute guidance, we went from two drugs to one drug. So the treatment you are taking now is significantly easier than what you got it and uh how like this is a treatment that is supposed to last one year two years three years because doctor flores says as long as my body tolerates but because you have stage four disease we are supposed to keep treating you until non-stop however after one year i would consider just giving you immunotherapy and the immunotherapy would give for maybe one or two more years after that you're still in remission we will consider stopping because there are miracles where people just do well without treatment but for now is what Dr. Flores says. That being said around August next year we may remove the chemotherapy and after that immunotherapy can stop a year or two years later. Got it. Something will happen that you're not going to be on treatment forever I don't think so. Okay do you think do you have any recommendations for other oncologists that would be be willing to follow doctor Flores plan that it's. Yes, you know there are very the good things that in San Diego there are very very good doctors and I would like to send you to somebody that you can trust the office and what you felt yesterday or on Monday, you don't wanna feel again that level of upset stress is just not good for you and I can't tell you that's not gonna happen again because of course we didn't do that to you. We've done that also to other people and with your level of I didn't know. Yeah. Very good. I'm going to send you to a doctor called Dr. Singh. She's a very nice lady. I would like her to be part of our team. She's just great. Okay. Okay. Sounds fantastic. Very good. They're going to be called for her office. But I think you should keep the treatment with us on December 27. And if you decide to switch, which you might decide to switch because closer to your home actually, I would like you to do that in January so the treatment doesn't get affected. Okay? And do talk to your primary care doctor about helping you with the Ativan. And I'm telling you there are some drugs you can use that you're not going to need the Ativan. Okay? Yeah. Do you think this could be from withdrawal of not having the medication for a while? Yeah, when you are withdrawn from the Ativan, you just feel that your body is crawling out of your skin. It's horrible anxiety. You cannot run out of the Ativan, but there are other drugs that they should give you. Okay? Okay. Gotcha. Gotcha. Well, thank you for talking to me today. I think we're going to talk to you again about the CAT scan and the MRI. I'm going to talk to Dr. Flores will decide when she wants to see you or talk to you about these results. I think she's coming back next week. So I'm going to have you talk to Dr. Flores about the MRI and the CAT scan. Okay? Yeah. Okay. Sounds fantastic. And let's go from there, you know? I apologize for causing havoc and creating problems situations. But like I said, sometimes the ultimate way to get something done is to actually be there and make it happen. Because the amount of frustration builds up over time. That's something I can't really control. And I can understand that you guys are overwhelmed and doing maybe too much by diving into other realms that are not oncology in a way. Very, very good. Well, it was nice talking to you and I'm sure Dr. Flores will connect with you next week after the MRI on the CAT scan, okay? Okay, all right. Thank you very much. Very good, thank you. Bye-bye. Have a good one. Bye-bye. I'm going to show you how to use the app. I'm going to go ahead and click on the button. I'm going to show you how to do it. I'm going to go ahead and show you how to do this. I'm going to make a cup of coffee." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 37 year old female patient presenting for initial consultation of left thumb injury after she fainted and fell in her pain two months ago. Hello, how's it going? Good, how are you? Is Leah? Yeah. Okay, nice to meet you. My name is Eugene, I'm one of the PAs here, I'm originally ortho. What's going on today? How can I help? Um, yeah, I just like... fell and injured my thumb a couple months ago and in the beginning like I couldn't open jars very well like it was very weak and I just never did anything about it I kind of just let it like heal on its own but it's still it still hurts sometimes it's kind of it's more of a dull pain and like I mean I can open jars now but it's not it's not a hundred percent yeah and like I just want to make sure it's like healing okay and or make sure I don't like need anything special. Sure. How exactly did you enjoy it the first time? Uh I fainted. You fainted? And I was trying to I think I was trying to catch myself on the counter or the kitchen counter and I think I just like bent it a weird way or something like that. Gotcha. And then when you woke up you were like what's going on with the hands? Yeah yeah yeah I was like on the floor crying. Oh sorry. I was just like I was like oh god like making sure it's okay. Yeah, I just think that it just hurts really bad. Where was the pain initially? I think it was... I mean I feel like it's in the base, but it does... When I bent it, I was trying to get it to feel weird. I feel like it feels a little tight. So it's always a twisting motion that you feel like there's a lot of pain? Yeah. I guess so. I mean it's just I mean you know you're using your hands all the time for everything so I think uh I mean anytime I have to put like a lot of pressure on things then it's it just kind of hurts a little bit it's not terrible like it's. Was there any bruising that showed up? No it didn't show up. I'm using it and I don't remember any swelling at all. So I think I had to put any ice, or I don't know if I put ice on it or anything. Okay, let's see you give me a thumbs up. Okay, and moving in circles. Any pain with that? Not very low. Very low, okay. That wasn't an injury, right? No. Okay. Anything here? No. There's no sharp pain with you pushing on it, right? Or me pushing on it? No, I mean, I felt like I felt a little more like anything. Right here? Or something? Is there pain here? No. Did you ever have pain like right here? I don't know. It's not like very direct. I guess. Yeah. You okay with this? Mm-hmm. You have that motion? No. No? Yeah. I don't feel anything here though. No, not really. So what are the things that you do to replicate the motion? pain? I mean I get well I mean this like bending it all the way that way kind of hurts but when you do this it hurts. I know my I mean I do have pretty flexible fingers like you know like I feel like I have a lot of range in my fingers so like I feel like I have to be doing you know like pulling something or for it to hurt. But it's like I said, it's pretty minimal. I just... Not quite back down. Yeah, and it's just taking a long time. So I'm like, should I be like wearing something? Or I don't know what. And maybe that's just normal with this kind of thing. Where it just is a slow, slow recovery, you know. I'll do this. Are you spending up and pushing out against my finger? Any pain with that? No. No? No. Okay, not pushing out? I mean, it hurts my face, like when I lock my... It's always here, that hurts, huh? Yeah. Right? Yeah. And does it hurt right now when I'm pushing on it? That's the most I can feel when, like that's the most pain I can feel when you like kind of push it right there. But it's, yeah. Okay. I don't know what starts. I feel like I didn't really feel it that time. I don't think it's that far down. Yeah. I think it's like in the middle. Okay. Try to extend it out. Okay. Pushing. Push, push, push. No. Not really. Okay. And when does this injury happen? In November. November. Beginning of November. Right. End of November. I think beginning. Okay. I think it's like in November. Yeah. Listen, we're not really able to see exactly where the pain is coming from. The X-ray looks fine too. Sometimes, if it's like a finger sprain, that can just take a little longer for it to completely resolve. Now, a lot of times, there are several key things that are very important, which is more of the UCL ligament right over here. When you rupture that ligament, it makes it very difficult to grip onto things, to hold things. Just because we basically require this. to provide stability. You don't have any pain with me stressing that in this way, do you? No. Yeah, and then the other one is the RCO which is over here. You don't have any pain with that either. No. There's a possibility that this just, you know, if you feel like this is mostly gotten a lot better and just a little bit lingering, there might be just a lip valve finger sprain. Okay. Which can take three months or so to get better. How much better would you say you've gotten in the last two weeks? I mean definitely significantly better. Like 90% better? Yeah. Okay. I just want to, yeah, I just I mean I figured yeah I probably I mean obviously if I couldn't like hold things that would be an issue but yeah I mean I can still do things and I can like sometimes I'll switch what hand I'm doing something with just because it's It's like a little tender. Yeah, but yeah. Okay. So so how about this? Let's give it like another month or so and see if there's still any like significant issues. Okay, if you're still having quite a lot of pain at the point of doing things, you know, you find that you're not able to do certain things because of the pain that make it know that let us know we can double check and then maybe we can always order an MRI. Right now everything looks good for kind of. really able to reproduce the pain right here so let's just keep a close eye on it okay okay yeah yeah sorry i don't have an answer for you no it's okay but at least everything looks good yeah yeah yeah okay yeah i just want to make sure everything in turn like with an x-ray it looks so good yeah there's nothing like feeling weird or something like that yeah i don't see anything right now the reason for the x-ray right here the area that you're talking about that you have a lot of pain is more like a... over here at this part of the finger. Looking at it this way, don't see any pieces of bone that's fractured off or anything like that. So all in all, it looks pretty good. Okay, cool. Okay? Good. Yeah. Good, good. Alrighty. Please insert a left thumb through the X-ray, that's normal. Please insert a left thumb. So left hand exam. That's normal. This has been planned. This is a 37 year old female patient presented for initial consultation of left thumb injury after she fainted and fell on her hand two months ago. Patient overalls noticed approximately 90 to 95 percent improvement and... wanted to get an evaluation due to still having some intermittent soreness in the thumb but otherwise no significant discomfort in our normal day-to-day activity period. Our patients left thumb x-ray today which did not show any acute findings period. On exam, common patient also has no reproducible pain But as note, some soreness. After testing, an examination of the left thumb that's non-specific period. We discussed with patients that we did not see anything acute at this time and that she might have had a finger sprain which can sometimes take up to several months to completely resolve period. We discussed about giving a close eye and monitoring the left thumb to see whether there are any reproducible pain or lack of improvement over the next month period. We'll see her back then for repeat evaluation. Period of patient continues to exhibit. If you have significant left-hand discomfort, we can consider ordering MRI, period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm seeing Mrs. Hernandez at a one month interval follow-up. Delete that. I'm seeing Mrs. Hernandez at a two week interval follow-up regarding a history of iron deficiency anemia and MGUS. Period. She also has a comorbid rheumatoid arthritis that has been stung. stable for her, period. At the time that I last saw her, I ordered follow-up laboratory studies to assess the of her iron status and MGUS parameters. She was last given injectifer on 7 slash 7 and 7 slash 19 slash 23 period. Her MGUS is characterized as an IgG kappa monoclonal protein. 19 period. Next line, 10 slash 19. 19 slash 23 colon, hemoglobin 12.9, MCV 97, ferritin 541, IgG 1095, and the K slash L ratio 2.39 period. Next line. The secondary studies were obtained prior, but were obtained on 4-23. Next line. 4 slash 23 slash 24 colon WBC 5.5 comma H slash H 13.1 slash 39.2 comma platelet 211 period. CMP is completely normal period. Ferritin 454 nanogram per ml. Parenthesis compared to 10 on 5 slash 6 slash 22, close parenthesis period. Reticulous site count 3.3 percent period. Beta 2 microglobulin 2.2 period. IgG, 1,199 period. K slash L ratio 2.53 period. Thank you, thank you. I just wanted to confirm. No, no, of course. This is Hernandez in room three. Doctor, should I pull you out once I get him on the phone? Yeah. This is Hernandez. Welcome back. I'm glad you came back so we could have these lab studies. As I said, I was concerned. We gave you intravenous iron last year that we have to be sure you're stable. And I'm happy to report that you are. Good. You have plenty of storage iron in your body. Your hemoglobin is 13.1. And let me. What should it be? Well, that's normal. Normal range is 11.1 to 15.9. The reason I was saying I was going back is last October it was 12.9, now it's 13.1. Virtually the same number. Your immune globulin levels for MGUS, virtually the same. So everything. looks stable. As you may remember, I've told you before, an adult who becomes iron deficient is losing blood. So I'm worried about that. The ferritin level, which is storage iron, was 541 last October, and now the ferritin level is 454. Very, very good, but it's decreased. So my concern is, and I don't know this is true, is that iron is being used to make blood. As I... Iron is used to make blood that ferritin, which is storage iron, decreases. So you've got an excellent hemoglobin that's stable, but you may be keeping it stable by using up your iron available. So I still worry you may be losing some blood. So I need to see you, and I'm gonna suggest I see you by the end of August. And we check these numbers again. But you leave here today knowing they're all stable. Okay, that's very good. Yes, just a sec. I'll be right. Okay, so my plan is you're fine, don't do anything different. If you see blood leaving your body, I mean it looks like you may be losing blood somewhere, that's important to let us know. Because without seeing it, I'm just looking for evidence that it may be going on. And it's a treatment plan. I'm gonna set things up for what I want. Just one second here. Okay. D47, glenogemopathy, right D50.8, right D64.89. Okay, testing. So I want a CBC, CMP, ferritin, binding capacity. Retic. Hey, poo. All right, globulins. So I'm going to look at your immune proteins, which have been stable, but most significantly to make sure your iron is stable and your blood count is. And if it's stable, that's great. But I'm looking for trouble, okay? And if everything looks okay, we can take a longer interval after that. Okay. All right. Thank you. Thank you. So we'll get lab August 30th. I'll see you September 6th, all right? Now I think you're doing fine, and I don't think you're going to feel different. I'm just looking for changes in your labs that will tell me how stable things are. Do you have any questions for me? It just doesn't tell you if I'm so tired. No, no. I'm not tired for your blood at all. Not at all. The most common reason for tiredness during the day is sleep deprivation. Not getting enough sleep at night. Well, I don't know if you get up frequently. Do you get up frequently? Yes. Well that you may not get deep sleep. You may not get the kind of sleep that gives you rest. It's possible. If you're if you would like more information or to evaluate it you can actually have a sleep study to see how you sleep at night. But you're not tired during the day for any of the blood issues at all. Not at all. So my impression today is number one, a history of iron deficiency anemia with no past observation or current observation of bleeding. Two period, IgG Kappa M Gus period, the protein values are stable. Three period, reported tired during the day. I have attributed to sleep deprivation. discussion. I'm very pleased to note the normal and stable hemoglobin, comma, iron studies and immune proteins regarding stability, period. However, the ferritin, comma, albeit being very good, comma, is decreased from the previous measurement in October of last year period. It will be important to observe looking for stability of... and of course I counseled Mrs. Hernandez regarding any observation of blood loss, period. I attribute her tiredness during the day to sleep deprivation, period. She gets up frequently at night and this may be the reason, period. However, comma, a sleep study may be important at some point, period. I did reassure her that her hematologic picture is not a cause of tiredness, period. Plan number one, follow up in approximately three months with lab prior colon CBC comma CMP comma reticulocyte count comma erythropoietin level comma ferritin comma I slash TIBC comma quantitative immunoglobulins and free light chains, period. Any questions? No. Good." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hi, how are you doing? Good, good. How are you? Hi doctor. Good. Okay, so you're taking two twice a day, right? Yes. Okay. So everything is good. The white count has dropped down a little bit. So we may have to adjust the dose. So it's no big deal. Otherwise platelets are okay. Let me, here you are. Okay. 3.1 is the white count, but hemoglobin is good. platelets are okay. 1.9. Okay. So that's common with that medication. Yes. So what I would have you do, one day you take four or two twice a day, right? Yeah. And we take one in the morning and one at night. Oh, that's it. Oh, okay. Okay. Not two. That's okay. So one day you take two. One in the morning, one at night. Okay. Or you can take two together. Oh, okay. Yeah, it's no problem. Okay. So you take one day two other day one then two then one. Okay like that So it will make the white count. Oh, so it can make the white count go up. Yeah. Yeah So on the platelets we'll watch and see if as long as they don't go up too high then they're okay What are they now? 477. Okay. Yeah, so you're okay. Okay. All right. Two and one, two and one. Two and one. Check in two months. Okay, two months. Will we see you or the girl? Okay. I'll put it in here. Sometimes they switch it, but I put it for my group. Thank you so much. Take care. Have a good day. Bye bye. They'll help you. Take care. all questions answered, comma, reassurance was given in counseling with impaired." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 28 year old returning patient, sorry, a 28 year old female returning patient with a new complaint of right knee pain that began approximately two months ago, a traumatically. Leah? Hello, my name is Lindsey. I'm one of the other physician assistants here. Good to meet you. Tell me a little bit about what's going on with this knee. So it's gotten a lot more painful. I usually run a lot and it kind of just slowly started getting more and more painful and usually I just run through which is probably not good but like a few weeks ago it was really bad so I stopped and was trying to get ibuprofen, just let it rest to not impact stuff so more like yoga and things like that. But there's like, there's definitely a bump there. And I don't know if it's like what it is, but it really hurts when like, now when I walk downhill or upstairs or something, it really hurts. Like I was hiking and it was pretty painful. If I like kneel, I kind of like stretch that part out like that, that hurts. So yeah, it's just kind of to the point where like when it's, aggravated to, it's really painful to do anything. So I just walk flat. So yeah, just... I think the rusting didn't help. I should probably come get it checked out. And has this ever happened before? No, I mean I've had patellar tendonitis. I've had knee stuff, but not... for a while, not anything super crazy. Just something that PT and kind of off of it helped with so okay and any symptoms on the other side really I'll just right here okay I think it's like the month else about concerns they are repressing right here anything here no Or here. No. Anything here? Nope. Going back to that spot. Anything right in here? Yeah. And that's the worst kind of right there? Yeah. Push out against me. Is there pain with that? Do you feel that? No. Anything farther down in here? I guess it makes this sore. Kind of like my shin. Anything right in here? Okay. Now you do lie down for me. I should be putting that in there. Let me have you raise the leg straight up and then resist me. So push into me. Any pain with that over that area? Okay. And then relax for me. Any pain here? Just got it right kind of in this area. Push your knee down into the bed to kind of hyper extend your knee. Like they're kind of contractor quads. Yep, yeah. Is there any pain with that? No. Okay. You can sit on up. So your tibial tubercle is what kind of sits, oh, don't touch it. Is what is right here. And that's where your patellar tendon inserts. And so we know that when you get bad enough, basically like what we call insertional tendinosis, so right where that tendon touches, usually the tendon becomes inflamed first. Because your insertional tendinosis over time is actually it's worse, it's actually gonna start inflaming the bone and you'll start getting fluid or inflammation in the bone. And so you're definitely tend over that patellar tendon, but also kind of right over that bone and that's where you see a little bit of that swelling. So that you're kind of having that secondary component to it where the bone is now getting inflamed. It looks healthy here on x-ray. Sometimes if you have kind of actual bony prominence here, that's indicative of having oscars and schlatters. Did you have that? No, but I... I did a lot of webmd-ing and I was like, I hope it's not. It didn't sound like it was, I don't know, how that would have randomly. Yeah, often slaughter only happens before your growth plates close. But it then can lead to a lot of development of patellar tendinosis and stuff like that. So you can't develop that now at this point. But sometimes you still see evidence of it actually. I don't see that here. This all looks fine. It doesn't look like you have that as a kid. I think this is more just patellar tendinosis developed by itself. and it's now really inflaming that bone. I think taking a break from activity was the right thing. I just don't think it was long enough. Typically when you start having that actual bony edema and injury, it takes sometimes a couple months of no high impact activity to go away. It takes a long time for bony edema to resolve. So what happens if I got obviously arrested? What would happen if I didn't? It would just be painful or like? It typically just doesn't resolve. or it takes much, much longer to resolve. And so I've been getting you back into PT to kind of work on this. I would say, have you tried a patellar tendon strap? Some people like them, some people don't think they do anything. They're a pretty benign kind of easy thing to use. So I say, let's potentially try that, just a strap like this. You can buy them on Amazon. But it basically doesn't sit over the bony part, it sits right over the tendon there and it helps I was just taking like ibuprofen but it didn't really, like I guess it helped with the pain a little but like it didn't like stop the pain so I just, yeah, I've been taking that. And do you take any other daily medications? Just birth control. Okay, I would say let's bump you up to diclofenac, it's kind of like a brother to ibuprofen but it's a little stronger. This is prescription only. And I would say let's have you take it every day for two weeks. Because those things work best when you take them consistently. Let's see if that really helps calm us down. It would be icing two or three times a day for 20 minutes. Lots of activity modification. If it's causing pain, modify or stop that activity. It's kind of like having tibial stress syndrome or any other kind of stress injury. You just have to kind of do a little bit of trial and error and just give this time to resolve itself. So if it hurts it, don't do it basically. And then as it gets better, it's that kind of slow progression back into things. I'll put in the PT referral to also do a return to running program of making small steps and kind of building back up to things so it doesn't re-aggravate it. Do you know if there's any other underlying issues that trigger? I just feel like I keep getting injured one thing after another. It hasn't been this, but it's been a million other things from running. Do you think it's all connected somehow? I feel like I should get frustrated because yeah, like I'll heal from one thing and then something like this happens and it's like a whole other, but it's like a whole other part of my body and like, I don't know, I'm just wondering if like I'm just doing something wrong or like if I should just like be PT like constantly to try to like, or if it's like something like with your hips that causes it, like knee stuff. What other kind of injuries or things have bothered you with running? Definitely like my hips, like I've had some hip Like I said, that was like the latest thing. I was having some pain here, so I was in PT for that. I ruptured this tendon, my posterior tibial tendon, twice on this foot. Stress fractures on the feet from running, because I used to run track, so it's a lot more. But yeah, so it's just been like a continuous thing on the heel, and I don't know, I just, I want to keep running, but I also feel like every time I try to train for something or I'm running a lot, something breaks down. So I'm just trying to figure out if it's like, OK, maybe I should not be running, if I should be doing PT if I'm going to keep doing impact type stuff just because I have run for so long. Yeah. So we do have a lot of our runners who are typically just in PT on and off for almost just for advice kind of when things pop up. And so I do think there's a whole function of just making sure everything is conditioned in the body so that if one thing's not conditioned, it's not kind of taking the brunt of things. One thing I think about is that sometimes we see and we know that stress injuries occur when people have low vitamin D status. So I'm happy to send blood work to test your vitamin D to see if that's potentially causing kind of these bone injuries or stress injuries. We could see if that is maybe a culprit. Otherwise, we know we just know that high impact stuff is hard on the body, like running and that it may just be some kind of constant tuning up to make sure the body can handle it. Do you think this could be a couple months? If you're that tender right over that bony area, I'm thinking it may take a little while to resolve. Hopefully not. Maybe just, again, anti-inflammatories, lots of icing, just kind of staying on it will resolve it quicker. But yeah, when I see this, it does usually take a little while. What PT place do you like to go to? Yeah, I'm gonna be at some like movie on SF. Okay, basically I'm going back to New York. Okay, so I'm PT that I don't know if they're covered on my insurance. I guess I'll just have to figure that out. But maybe I could still just get a slip or something like some sort of referral or prescription. Maybe I can try to get it taken care of. If not, then I'm coming back in the new year and moving to New York. to LA, basically. So I don't know all the places. All the big cities? Right. So I don't know if all the other lists started here, unless there's a place that does virtual, maybe. But I don't know if anyone does any more. I know some used to with COVID, but I don't think they do any more. Yeah. Because I literally am leaving Thursday morning out of the state. So it might just be something that I have to find out but I just wanted to know if I should, what it was. Yeah, I think it's all related to that extensor mechanism. You don't want any swelling in the knee. I don't want this coming from anything inside the knee. It's all probably external to the joint. We do most of our PT referrals and pretty much everything by fax. And so I'll send you, it's going to give you the PT prop to pick out a place here. But you can just respond to it. If you find a place in New York, just send us the fax number and the name, and then we can send it for you. OK. Awesome. I'll pick up this prescription maybe tomorrow or something. Yeah, I'll have them confirm your pregnancy and I'll send it tonight. Okay, awesome. All right. I'm sorry about this. Do you want me to send blood work requests for vitamin D? It's okay. Okay. Just because I won't be able to do it here for a little bit. So maybe it'll just be something I do in the next year, in the new year, I'm looking to. Sounds good to me. All right. It was good to meet you. You too. I'll send you. I think I have some patellar tendon extra sites. So I'll send that to you via email. All right. Thank you. Of course, I don't have time when you're ready. For Leah, we need pharmacy and help is needed. Please add a right knee examination. There is tenderness over the patellar tendon and tenderness over the tibial tubercle with mild edema. There is no pain or weakness elicited with resistive knee extension. Please add a three view non-weight bearing Great knee x-raying today in clinic and reviewed which shows no acute fracture dislocation, common skeleton, common normal alignment, common no overt joint space narrowing. Please send PT referral for right patellar tendinosis and tibial tubercle stress injury. Please work on knee conditioning and pain resolution and then incorporate a return to running program engagement evaluation. Please send a teller tendinopathy education. Patient's going to follow up as needed as she will be moving out of state. Sorry, moving out of San Francisco." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Oh, room seven. I'm sorry. Hola! Welcome back. Okay, so how are you? I know I'm back with the translator. So the numbers are better. 112,000. So normal is between 150 and 400. Normal is 150 and 400 in my opinion. And 200 for the whole family that I have. So she just wants to know maybe possibly because he wasn't feeling good that it was dropping? Maybe. Possibly. Maybe. It's hard to know for sure. It's very hard to know what happened in the beginning. So I think what we'll do is keep him on the schedule of every two months. instead of coming in every two weeks because I think the platelet counts are okay. But I want to educate you guys on symptoms of low platelets. So when platelets drop really low, people can start getting bruising on their legs or their arms like big bruises or they can start getting little dots like little tiny red dots and they're called petechiae. So if you ever notice that you have... to call us. So this is what you want to call symptoms of when the skin has been cut. Normally they are small, large, in all the hair. Because the hair is very small. Yes, they are very small. Also they are like small, like small roaches in all the hair. That also means when you are small, that the hair is not as small as the roaches. So you have to have the efficient hair or small roaches. bleeding. Does that make sense? Yes. Because I think you know if we keep checking it every two weeks of course there's going to be some fluctuation but as long as the platelet counts are not very very low we don't need to do any treatment. Sí, yimos monitoriendo la sangre cada dos hermanas, siempre vamos a vir y bajar porque es muy pronto. Pero si no miramos cada, vamos a mirar si sube no baja. Porque hasta mOS estará no más tiempo, socada dos meses, y lesa camos sangre miramos, sí, as normal, como los tienen un solo número, o sí, empahando su diendo. Um... Is that okay? Okay. Okay, perfect. Any other questions, sir? He is a doctor but I don't know if he is a doctor at his primary care. He has a lot of pain in his back. Does he just have pain in the lower back? No, he has a lot of pain. Is he a doctor? No, he has not been diagnosed with this. He is not too sure because he has never been diagnosed with sciatica. Do you have a primary care doctor? Is he a doctor at his primary care? Yes, yes. He is following up with them. I'm with your doctor, first of all, because I'm a chicken. We know that here, as a specialist, we don't have much time to do the doctor's work, but we do it with the doctor. Sorry. Okay. I'll read it to you. Okay. So, how do you say sorry in Spanish? Pero. Pero? Okay. Any other questions? No, thank you. Okay, alright. Nice to see you as always. I would like to thank you for coming. We will see you soon. We will take care of you. Thank you. Bye." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " For Peter Green, ultimately we are able to, with multiple efforts, draw 60 or sufficient ML, sufficient blood to make up for 60 MLs to centrifuge and the PRP was, the Verizon PRP was injected into the right knee aseptically without difficulty after pre-injection of the skin only with 1% lidocaine and .25% epiphytocaine. Triple follow for after this needed period of Dogs, this isps destroys Dhhhhhhh This is Amb valves of space what you have to calculate the width the thickness What you have to find is that the temperature of the ground surface or subject goals not very close to the ground is increasingly" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm seeing Mr. Wilmot today for the first time as part of a transfer of care regarding chronic lymphocytic leukemia period. He was last seen by Dr. Eisenberg on June 7th of this year. Dr. Eisenberg noted a rise stage one CLL and discussed ongoing followup in to six months. Six months have passed. This follow-up is part of that plan. Most recent CBC, well I should say most recent laboratory data showed a white count of 39,000, an absolute neutrophil count of 5,300, absolute lymphocyte count of 30,800. His creatinine is 1.16 with a EGFR of 61, total protein 6.0, albumin 4.5. Of note is from March 2019, a flow cytometry showed CD5 positive B cell chronic lymphocytic leukemia, ZAP70 and CD38 negative. I'm going to use a little bit of the same color to make the eyes." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 37 year old male who presents her follow up of a fifth metacarpal fracture that occurred approximately six weeks ago period. He was last seen in clinic one week ago to have his cast removed one week early because he was leaving on vacation to Hawaii period. The patient reports he's been complying with non-laboring recommendations as discussed at his last visit and it's been protecting his fracture and a brace for an adjustment. additional week period. Reports that he no longer has pain over the fracture site period. Please copy over prior right-handed and wrist physical exam. Please insert a right-hand x-ray series with a fifth metacarpal shaft fracture with no interval displacement and good overall alignment period. Significant callous formation, demonstrating fracture healing visualized period. Processment plan. Patient is a 37 year old who presents her fall above a fifth metacarpal shaft fracture that occurred approximately six weeks ago period. The patient did have his cast removed one week earlier than recommended as he was flying to Hawaii for vacation period. He has continued to maintain a non-warping status with his right hand and utilizing a brace for protection for an additional week period. He no longer has tendinitis to palpation over the fracture site today period. Discuss with the patient that I would like to initiate him in hand therapy to work on overall hand strengthening period. The patient will return to follow up in three weeks. evaluate his progress. Period. Please send our full for hand therapy for healed fifth metacarpal shaft fracture. Period. Please work on right hand strengthening and range of motion. Period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Who presents today for MRI review to his left knee. He saw me as a new patient in September. He was a referral from Dr. Anderson period. He has had surgical procedures with her including an open osteochondral allograft period. Unfortunately, he has had continued pain from... his cartilage damage period. He has grade three and grade four changes known throughout the knee period. As a result, the patient was sent to me to discuss potential partial versus total knee replacement period new paragraph. MRI reviewed with the patient today shows no significant cartilaginous or meniscal damage to the lateral compartment. to the patellofemoral compartment. There are the already known grade three and grade four changes to the medial compartment with full thickness chondral loss and significant truncation of the meniscus, all consistent with his prior injury. Period new paragraph. Please copy for a prior left knee exam, period new paragraph assessment and plan. Who presents today for MRI review to his left knee? Period. MRI confirms that both the lateral and patellofemoral compartments are fully intact with no significant chondral disease. As such, we discussed at length today that we can proceed with a partial knee replacement versus the total knee replacement as we had discussed at his last appointment period. He will follow up at the time of his previously scheduled surgery period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Who presents today for a follow-up on his left knee period overall. He has been actually doing a little bit better more recently. He was on a trip to Japan where he was walking up to 10 miles a day for over a week and he actually did quite well and had pretty minimal soreness. He knows that since then he has been feeling a little bit optimistic about the knee. He still notes that there are twinges. He still does not feel like he could ever get back to running. Period. At this point, he has tried both cortisone and PRP injections with limited improvement. Period new paragraph. Left knee exam is deferred due to virtual visit today. Period new paragraph assessment and plan. Anthony is a 44-year-old gentleman. Status post to medial meniscal debridement in July of 2022. He never fully recovered, but we did find him. signs of some full thickness chondral disease during his surgery as well. Period. We have tried both cortisone and PRP with limited results. He does seem like he has improved slightly over the last few weeks. Period. We discussed that at this point, I really do not see any immediate role for revision surgery. He has a recent MRI from October, which shows maybe a little bit of recurrent undersurface tearing, but no real interval changes in the knee. Period. We'll see if you'd like to try how your. acid injections as such we'll bring him back for that and we will go from there." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Well, hello. Hi, how you doing? Good. How are you? Great. Passed the six year mark from finishing treatment. Really? I'm done. Yeah. No, I'm saying you passed the six year mark from finishing the treatment. That's awesome. I know. Pretty good. It is. Thanks to you and knowing what to do. I'm part of the process. So, it's a combined effort. I know but sometimes I send you to the right person. That's right. Thank you. Yes, no, no, everything is looking fantastic. Oh, good. The scans look great. Vision is the same. And blind in one eye. But I mean, no changes in the other eye or this obviously. No, no, this is gone, so no. Yeah. When you were getting treatment, it was kind of going away at that time. What? The vision on the left eye. No, what happened was, when I went to Dr. Char, he told me to only do four. So they'll... When you said to this other guy, Dr. Munson, because Dr. Char sent me down here, so I thought he didn't want to treat me no more. Well, he told me I don't want to take four treatments, but this guy gave me 20. So I'm, you know, and I think what happened, it just, then he eats it out, eats it more and more. Yeah, I don't know. I think what he was talking about four treatment was just directly to the disease process. And it's extremely difficult to do pinpoint because there's risk for a recurrence. So that's why I think he made. have given you full treatment which means that the cancer doesn't come back and thank goodness when that's what's happening but the vision obviously is gone. I think if I had told him to call Dr. Char because that's the fourth treatment I could see perfectly well. But yeah if I had told him but I thought you know Dr. Char sent me here so I thought well. Yeah well unfortunately what I've seen is it's not when you're getting the treatment but it's in in months that the vision or you know things get Just like people get radiation for prostate cancer. The control, it takes a year for them to have the control affected. It doesn't happen right away, for example. Well, what happened later on, I mean, the retina tore out my eyes. We had to replace the retina. It was just a mess. And then, now I can't see. I know. I'm sorry. It makes it... At first, everything just goes flat. You can't... nothing. You can't tell the difference. Yeah. But eventually, this eye seems to take over pretty good. Yeah. Yeah. So, what I would do, because it's six years, you know, the chances of it coming back extremely low, I'm okay doing a chest x-ray once a year. If the chest x-ray shows something, then I will do the PET scan. Not 81 years old, how old are you? No, 81, wow. Yeah, I mean, what? Well, what I'm saying is, these days, thank goodness, the treatment is much easier. Oh, good. So, even if you see something, we can give like just immune therapy to control it. Yeah. Okay. Thanks. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. So, you know, that's why I'm saying that I will next year do a chest texture before I see you. If the chest texture shows something, then I will do a PET scan. The chest texture being lateral in one year, but annual screening slash restating lung cancer. And follow up in one year. I had some bone in my bones, my ribs I had cancer. Did they show up anything? On the PET scan, no. It's completely clean. I like the small readings. His undermark was scanned. No suspicious uptake in lungs or anywhere else. Symmetric uptake in the orbits and globes. No bony evidence of metastatic disease. Everything is clear. There you go. Yeah. So that's what we will do. A chest x-ray and see you in a year. Are you up to date with your, well, mammograms, now you can do every other year. I got an appointment from June. Okay. I already got the referral a long time ago but I can't get one every year. Breathing is okay, no cough? I have to clear my throat all the time. Better than that. Okay. How about calling us? I think you're up to date. Yeah, I am. I don't think I can get another bowl. Let me get that. You will not do it beyond 80 anyway. Usually they like not to do it. Good, I ought to drink that crap. I hate that stuff. Deep breath. Okay, all right. See you in a year. A year? Yes. Bye. I got that port for you, think they can take that out now. Interval history. Sandra has been doing really well period, as we know that she's had non-small cell lung cancer, which was metastasized to the ribs and orbit coma. It has been six years now that she finished her treatment with ketrogirida period. There's no witness of any active disease. Pet scan is negative, completely period. She wants the Metaport out period plan. Sondra's doing well period of this wind coma. There's no witness of any active disease period plan. Is to from now on do just chest x-ray annually. I will do that x-ray in one year and see her back at the... that point period we will arrange for Mediport to be removed period unfortunately she cannot see from the left eye since the treatment period all questions about accommodations for the women in counseling and then we're copied over doctors" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "This is a 32-year-old female presenting today for the follow-up. She was last seen in July of 2023 regarding a low back injury that had happened in May. She had a disc bulging on MRI, but it overall responded well to anti-inflammatory. She says that she's been doing well. However, about two months ago, likely from working very long hours, she began getting worsening pain and significant tightness extending down the left leg.She's also now getting more severe pain on the left side of her hip. She's hoping for treatment recommendations as well as would like to discuss potential work accommodations. She notes that she would like to potentially do some short-term disability so that she can focus on physical therapy again and anti-inflammatories. She works as a consultant currently. Please add a, sorry, please copy forward a prior low back examination. Note a negative straight leg test.left hip examination which shows tenderness over the greater trochanter and a positive over. For assessment, this is a 32-year-old female presenting today for follow-up regarding low back pain that began after lifting injury in May of 2023. She's overall been doing well since she was last seen in July but has had return of pain over the last couple of months. This seems to be likely related to her prior back injury but she'salso exhibiting signs of greater trochanteric bursitis. She responded well to an oral medull dose pack before, so I'm going to send this to her as well as a muscle relaxer. She's requesting short-term disability. Discuss that I'm okay with doing this for a month while we get her back into physical therapy and try to get her symptoms under control. If she needs any further accommodations in that, I am going to send her to a spine surgeon for further consultation and accommodations. We will approve disability from May 6th, 2024 to June 3rd, 2024. Please send a generalPT referral. Follow-up two weeks." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 25 year old female presenting for follow up now six weeks status post a left knee ACL reconstruction with quad autographed and medial meniscus repair. Patient states that she's been doing well and has been working on range of motion as well as started strengthening exercises with physical therapy. She states that she has been wearing her brace at all times however this is getting quite annoying as it tends to be slipping down her leg. She also presents today with one crutch. She states that at home she's walking without it but always has it with her outside of the house. Please add a right knee examination extension. Five flexion, 85, one plus. No, sorry, small. No, sorry. Trace knee effusion incisions are clean, dry, and intact. There's a resolving. faint maculopapular rash. Near the incision sites, there is no erythema surrounding the incisions. There is dry scab formation over one incision with no expressible exudate. There's no tenderness to palpation at any of the incisions. For assessment, this is a 25-year-old female presenting for follow-up now six weeks status post-a left knee ACL reconstruction with quad autographed and medial meniscus repair. The patient states that overall she feels she is improving. However, I'm unfortunately disappointed with her range of motion on examination today. She's still significantly lacking inflection as well as extension. We had a long discussion that she needs to be working very aggressively at range of motion exercises and I would like her to discontinue her crutch and brace at this time as I think this is limiting her from making some of her improvements. She will be doing some travel, but we are going to follow up in three weeks to discuss that if she's not had any significant improvement in range of motion, we are likely going to have to proceed with a manipulation under anesthesia. Patient gives her a full understanding of this. And we'll also inform her physical therapist of this. She will follow up in three weeks, no imaging needed." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " To see you because of your Blood issues is that right? I'm trying to figure out your blood counts have been a little low, huh? And how long have you known about this? Your numbers are not bad today, so I don't know what your guys are doing Like 120 is not bad And I'm looking at your numbers from last year David CBC same before take one please Laura, so again, I'm looking at your labs and the other stuff, your numbers today are really not bad. It's borderline. Okay. It's 120, which is not completely normal, but it's not very low. Okay. I'm going to run some blood tests today just to see if there's any other problem going on. I'm looking at your chart here. Last time you had blood counts done back in, this is May of 2023, the blood counts are 134. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. it was not bad from June, I'm sorry, blood work from September 2023 was borderline low. So really your numbers are not bad at all. I'm not sure why they are worried about it. We'll however check a few labs and if there's any problem, I'll let you know. I mean, they keep saying your blood counts are 130, but lower limit of normal is 150. So there's nothing to be done. So I probably I wouldn't have even seen you. I think you're on the list to be seen for the last year. But this, which means it's a good thing, right? Which means you are not worried about you. Okay, so let's check your labs again today. We'll check some other iron vitamins, thyroid, see if there's anything low to worry about. Hopefully there's nothing low, then we don't need to worry about you at all. Okay, today's numbers, you're at 115, our low limit of normal. is 140, very close. Okay, the most common reason, Nora, we are seeing issues with women your age, especially Hispanic origin, is we worry about fatty liver. Do you have any history about fatty liver? Yeah. Okay, so I'm gonna order an ultrasound of your liver. If it's not already done, do you have a GI doctor or anyone who does that? If not, let's do that ultrasound. If there's an issue, your primary care can refer you to a GI doctor. Again, there's not much to be done. other than maybe lose a hundred pounds. Do what you can. Do what you can but again it's just a matter of eating healthier, less carbs, less sugar, all the good stuff goes away. Just how do I say just green vegetables boiled not fresh. All the thing in your life, no alcohol. Yeah but whatever I mean you know it's a matter of a bit of those things. If there's anything else, I'll let you know, Laura, but I'm actually not too worried about this. So my feeling is I'm going to run these tests. I'm going to do the ultrasound. If there's a problem, I will even call you back. Otherwise my feeling is there's nothing, a blood problem for me to do. And your primary care doctor needs to watch it and maybe try and get you to a liver specialist in case we see that happen. Okay. If there's anything on our end of concern, I'll call you, but I'm really thinking there's nothing to worry about. OK, this is very commonly seen that 45, 50 fatty liver starts to happen. It's the most common cause of liver failure now. I'm not sure you're doing. You're not like a very heavy drinker. I don't know that. Yeah. Maybe that's the other thing you need to do. All the things which give you joy in life need to get rid of it. That's OK. You know, it's just just being aware of it, at least you can be a little bit more conscious. OK. So I'm just going to quickly talk about you if you want to listen listen if you don't want to listen you want to go that's okay too Okay, then Chief complaint thrombocytopenia is representing unless Laura seen in metallurgy for the fall of a borderline thrombocytopenia. She's apparently known to have Had blood work done in May 2023 at which time her plate at Congress 134,000 No other abnormalities noted. She was a photohematologist for further evaluation No increased leading of bruising is noted next paragraph on blood work in March of 2024 patient Not to have borderline thrombocytopenia plate of 115. Metabolic panel include liver function test, total bilirubin within normal limits. Very likely she has metabolic steatohepatitis, continuing with the interim instability, otherwise doing well next paragraph, past medical history. Negatives, other than hypercholesterolemia, social issues, negative occasional smoking, occasional beer, about six bottles a week. This is some negative physical examination, negative. What? Continue, No, no, I said continuing the recent thrombocytopenia Laura is in hematology for borderline thrombocytopenia she does not have any evidence of bleeding will check iron vitamin B 12 levels to make sure no deficiencies appeared given her age and slightly being overweight I feel this is most likely metabolic steatohepatitis I'll order an ultrasound of the liver to further evaluate again her numbers are very borderline at this time. without changing the underlying blood disorder. She does not need any further follow up with hematology, at least unless her platelets drop below 75,000. I will have her be seen by a primary care physician. Again, if her ultrasound does show liver, fatty liver, she needs to follow up with the GI doctor. We discussed eating habits, including trying to lose weight exercise to help with the same." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] This is me recording the first conversation chunk.\n[DICTATION START]\nNow I am on the first dictation chunk.\n[DICTATION END]\n [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Physical exam demonstrates two social worker styles. Posturetibial pulse to the left, but there is no tendinous palpation of the posterior tibial tendon. Maximum tendinous palpation of the origin of the plantar fascia to the medial calcino-tubercle. Ankle joint demonstrates 13 degrees of dorsiflexion with the knee bent and seven degrees with the knee straight. GS5 slash five muscle strength less than the plantar flexion. Dorsiflexion of the left ankle, no tendinous palpation Achilles tendon, posterior tibial tendon, parainal tendon, or sinus tarsi. Assessment planner, if I show you this plan. She has had two steroid injections, has tried a night splint, has worn a brace, and also has had a Medrolidase pack, reviewed other options to include potential repeating these, physical therapy, immobilization, or potential orthotic therapy was fitted with and dispensed or was placed in a low-night taping today. Should she respond fairly considered orthotic? Should she have continued pain, consider potential orthotic therapy? physical therapy, or immobilization." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm seeing Mrs. Hobbs at a four-week interval follow-up regarding history of medicine. Metastatic breast cancer. She's now on plugins. And... Philvestrant period. Cycle 3 of Philvestrant begins today and Ibrans continues 3 weeks out of every 4 weeks. So for the 21st of June I have a 1040 or a 1015 right there. I'll take the 1040. 125 milligrams daily for those 21 days. Period. Laboratory studies were obtained prior to this visit. Period. Next line. 5 slash 6 slash 24 colon. WBC 1.5 comma ANSI 0.9 comma H slash H 10.8 slash 32.2 comma platelet 165. Period. Okay, I'll be out front. I'm just going to sit down. CMP is normal. Period. CEA 0.7 nanogram per ml. Period. 27 dot 20. 974 unit per ml period this compares to 98.8 on 4 slash 4 slash 24 period. I mean of your eye brands because you had the lab drawn on the 6th of May how does that relate to when you yes so yes my last pill of the eye brands was on Was Friday night or Saturday night? Wait, hold on. My last one was on Friday night. Friday night. Yeah. Last Friday. That's a week ago. Yes. That's a week ago. Let's see. My calendar was May the third. and you had labs on May 6th. Yes. So you had the labs on day 24 of the fourth cycle of Ibrans. Yes. I had inadvertently, and I, when I, my first cycle, I was taking the Ibrans at noontime, and I was finding that that was really difficult because after I take it, it makes me so weak. So then my second cycle, I figured. I would take it at dinner time. And I was under the misunderstanding that you had to take it with food. Later on I figured out it doesn't matter. But anyways, in that week I had missed one pill. And I didn't know which day it was, but I knew that when Thursday came along, I still had one pill left versus being done on Thursday. So I called Eddie Friday morning and I said, should I go get my blood done Friday, even though I still have one more pill to take, or should I do it in medicine? day and he said Monday would be fine so you're getting Vasilidex today yes and typically that's when we would start eye brands yes one week off of eye brands yes yes so are you prepared to start your eyebrows yes okay good your lab that we had drawn at the end of the therapy showed that the white count was decreased although low not so low that I don't want to continue the eye brands because the CA 2729 is decreasing. Yes, I saw that. Okay. I did notice that when I look at LabCorp website it shows me the test results for April 4th but the C-corp website doesn't show me the April 4th so I was hoping that that could be fixed so that I could track the trends. Well I won't be able to fix it for you but I don't know what you want it fixed. Oh, just have that report there on the screen. C-Care website because the April 4th test isn't there. Well, that's software and I'm not sure how to manage that, but you can mention that to Ed. Sure, sure. But we won't be calling in software engineers at $400 an hour to make it compatible with LabCorp. I do not know what the software arrangement is. You should be able to see all of your labs there, I assume. Yeah. If you want them lined up against each other, that's a software development development. Well, normally you can see because they're all there, but for some reason the April 4th test is not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. is not showing up on CCARE at all? Well, they won't show up until I sign off, but I've signed off on things, usually within 24 hours of getting it back to me. At any rate, so the white count is low, that's Ibrans. If it drops lower in subsequent evaluations, then we will need to change the dose. But right now, you're getting a benefit by these numbers. I don't need to do any imaging studies with the tumor marker falling, it's very gratifying, that's what I wanna see. So that's my plan is to commence Faslidex today. This is cycle five, I believe cycle five beginning today. Is the Faslidex the one that's an infusion or the butt shots? It's your injection. My injection, okay. What infusion are you talking about? Ibrans is a pill. Yeah, but there was another drug that you had me do an infusion of. You're getting that now? Well, I got it once, but I've never gotten it again. And so I kept asking Eddie, when is that gonna happen? I don't know what we're talking about. So we have the injections, and then there were three drugs. So in my original plan. Infusion. Well, you've had Xgeva in the past. That's what it was then. But Xgeva, is that, I guess so. But no, you have not had Xgeva. some time. When was your last bone density? I don't remember. Okay and I should also think of your studies. Let's see we go back here your last X-Jiva was some time ago. How long ago do you recall because it doesn't look like you've had one. I haven't had one since that one. Okay let me see how far back that is. I think that was there at the beginning of the first cycle. Yes, you had a... Oh, I think it was denied. That's why it wasn't given again. I have no... It says denied. We don't deny it, so it would be from health plans. I assume. And I think it was done because of metastatic disease. So that's probably why it was not been given. So we can look at the bone density and see what's happening. The last, let me just look and see the last imaging. We have a PET scan from February. Yes, you have bone metastases. I want you to have X-Giva. That was on there. So I'm going to request it and we'll see what happens again. Okay. I want to set it... up every every month. So hopefully we have it authorized and we can do it one month from now. Okay that would be a way of setting it up so let's one two three four June 7th okay okay that's when I'll be seeing you next everything should be set so I trust we'll have that available. But you have bone metastases on the PET scan we treat for that disease. I don't know. Sharp may say we can give you medicine, but we don't want to give you X-Giva. They may not want that. That's what I would choose to give you, but I have no idea. That's all speculation on my part. I just don't know. Let's see, and we want a follow up. Your next. is six, seven, is that four weeks? I guess it is. Yep, okay. So I will see you on six, seven, and we'll get lab prior, and we'll get lab on the, about the last day or around the last day of your eyebrows. Okay, okay. I have a list of questions. Let me know when you're ready. Okay. Okay, what are your questions? First one, my general fatigue and weakness, is that something that's going to get worse or is that something that's going to get better or is that something that I should expect to be a kind of a static thing? I don't know, but I would anticipate with counts a little bit below normal that people can be a little fatigued and not feel up to par. Your hemoglobin is not a level that would cause any of those symptoms. So I would have to say it's probably going to be about the same. I don't see it changing. Kidney function decrease? Is it so bad that I should be taking an ACE inhibitor? Well I'm surprised by your question, such a specific question about taking an ACE inhibitor. I would not be planning any specific medicines for that. Okay. Weird symptom that I've noticed, and it's where when I lay down to go to sleep, I can hear my pulse in my ears. And I looked it up and it's like a form of tinnitus where you can hear your pulse, you can hear the blood flowing. And there. There could be different causes of that. Should I be talking to my cardiologist about that? Is that something you prefer? Well, you can be, but usually that symptom is pretty non-specific. You can certainly ask your cardiologist about it. Okay. But I don't know that there's a specific answer. Okay. And I don't think, is it all the time? Are you having it all the time? Every day when I go to sleep, but it's new. I mean, I don't remember it before. And then you don't have it during the day, just before you go to sleep. Yes. I'd ask your cardiologist, but I think that's non-specific. Okay. Okay. And... Okay. Oh, now... Oh, sorry. Maybe this is it. I ordered X-Jiva again, but you're getting a drug called Zometa every 12 weeks. And that probably is in place of the X-Jiva. I suspect that it is. I haven't gotten any. You haven't? Well, whatever they gave me that first time, maybe it was... Course number two was do... is due on June 7th, dose number two. Dose number one was on March 15th. I believe that was ordered because X-Jiva was denied. Okay, is that okay? I mean, is that in your opinion? My opinion is I wanted something to stabilize your bone. Got it. I would prefer X-Jiva. So call up your insurance plan and complain. I mean, I don't know what else to say, but there's an alternative and I'm using that. Got it. And so I need to cancel an ex-Jiva because it's I've ordered it again. It makes no sense. I mean, I didn't realize I was so supplanted with that. Any other questions? Yes When I can feel my lymph nodes in my neck and I noticed the lymph nodes were discussed in the PET scan results When do we do PET scans now when we're doing treating metastatic breast cancer as long as the tumor markers decrease I'm not going to repeat the PET scan. That's a sign to me there's less tumor mass, and I think we should just watch that until there's a maximum benefit, and then we can look at the PET scan again. Okay. And I noticed that in my blood results, the lymphocytes, monocytes, and neutrophils were down really low. Should I be concerned about, I know you mentioned bacterial infections last time, but should I also be concerned about viral infections? I don't think so. And I mentioned... to you already that your white count is low and I don't think there's a concern about that. It's low and that's something that eye brands will do but it's effective for you. So unless it's more significantly decreased I wouldn't change it. But as far as like social choices that I make as far as like being around large groups of people or anything like that. You can do whatever you wish to do but you shouldn't be intentionally exposing yourself to someone. You don't have any specific immunity or increased risk of viral infections. Okay and um Oh yes, okay, so the last one, I'm using up my sick time, so I need a new letter that extends my work release to June 6th. Okay, well Eddie can help with that. Yeah, and then sometime this summer, depending on how I feel, then I may continue my sick leave in the fall. fall. Well, we'll deal with it when we make a decision. Yeah, because we have a special program in our union for people that have severe illness that we can extend our leave. So we think that we've all contributed to. So yeah, I think—oh, bruising. I forgot to write that down. Anything I should be doing, because I noticed I'd be getting a lot of bruises. Anywhere else besides your legs? Just my legs whenever I bump up against something. No I don't think so. There's nothing about your labs that strike me as an issue. So I was pleased to see my tumor markers went down. Right, well that's the intent of treatment. That indicates to me less tumor mass." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "presents for requesting bilateral knee injection with cortisone period. The last injection performed four months ago has lasted until the present, but it's beginning to fade. Period of prefrontal examination she has.bilateral synovial hypertrophy of the knees without marked effusion period there's crepitation with general range of motion period uterine after giving for procedure colon after giving informed consent completelybilateral needs were aseptically injected with 1% lidocaine slash 0.25% marcaine slash 40 milligrams of Kenalog after ethylchloride slash beta-9 prep paired this with well-tolerated periodine para bilateral diagnosis bilateralosteoarthritis period where she stated she'll be defending her proposal at school before December period she'll likely return to see me about four months for a pete injection period and dictation" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'll visit for a name a second that I and efficiency Okay, that's a cool way. Okay. Hey Anna. I haven't seen you since December. And. And. Did you get the iron infusion? No. Okay. I thought that was what I was going to get today. Some kind of infusion or something. Well, you definitely need the iron infusion because your iron level was extremely low. We may try to schedule that back in December. I don't know what happened. What did you do to get a hold of you? I think this was for this one. Yeah, today I was supposed to get something done. I don't see anything. But yeah, today was supposed to be the foul walk after that infusion to see if it's back to normal, your iron levels, but... They haven't gone up on it. They haven't gone up because you haven't gotten the iron infusion. When we check all the other labs, when you were here back on December 27th or like December 27th... everything came back okay. You did not have any sign of B12 deficiency. They checked for certain kind of bone marrow cancer called multiple myeloma and that was clear. There was no sign of multiple myeloma. They also checked for any kind of leukemia or blood cancer or lymphoma. We did not find any evidence of that. It was really just low iron which I'm not sure why they... were not able to provide you sometimes they get bogged down by authorizations but you shouldn't have any issue because you have Medicare in the secondary. So I'm not sure why but I'm going to talk to them and try to see if they can get you an iron infusion today. If not today then they'll schedule that as soon as possible. It's gonna you're gonna need doses because it's really running on empty now. So we'll get you the two doses of the IV iron as soon as possible and then I'll schedule you for another visit in a couple of months and recheck everything at that point. I'm sorry you had to wait this long to get the iron but sometimes it happens. I'm not sure why but we'll get that to you as soon as possible. The only good news is I did not find any other Oscar Denim. Now I referred you to Dr. Padama, the gastroenterologist. Did you get an appointment? No. No, they were back. Yeah, let me talk to Lira and see where we're at in terms of that. And we'll go from there. Follow me. you" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Please insert a normal right ankle three-view x-ray and please insert an MRI request to Simon Med with comments MRI of the right ankle without contrast period please evaluate for Achilles inflammation slash partial tear. due to persistent posterior ankle pain without improvement with physical therapy." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Patient presents for follow-up of right wrist pain that has been ongoing since punching a wall on 10-28-23 period. CT imaging completed on 11-16-23 did demonstrate a 2 millimeter calcification suggestive of an age determined avulsion fracture of the tricute jump period. The patient has been weight-bearing as tolerated since his last initial visit, since his last visit period. However, coming he does continue to have some limited range of motion. due to some mild pain on the lateral aspect of his wrist and some continued associated swelling period. Please copy of a prior right wrist and hand physical exam period. For assessment, patient presents for follow-up of right wrist pain that occurred after punching a wall on 10-28-23 period. CT imaging was ordered to evaluate for a potential occult fracture and demonstrated a 2-millimeter calcification suggestive in age to determine evolution fracture of the tricrete jump period. The patient has continued to have decreases in overall pain and has been able to wait barers tolerated with the right upper extremity period. However, coming he does know that he continues to have pain along the distal ulna with associated swelling period. Prior x-ray imaging taken at the patient's last visit continues to not demonstrate any other occult fracture injury along the distal ulna or other midocarpal bones period. However, as has been over three months of the patient's initial injury, I would like to order MRI imaging to evaluate for any potential soft tissue TFCC or ECU injury period. The patient agreed to this plan and will follow up in clinic after completion of MRI imaging period. Please send an order to Simon Med for MRI right wrist without contrast period. Please evaluate for potential TFCC or ECU injury at the right wrist period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Government had an idea before they even met. I'm convinced everything is just not pleasant. We're talking about something the next thing you know my wife's on her phone and Facebook offers are what we were talking about. And I'm like, you didn't Google that, so I think the last thing is must be pleasant. We have seven. Oh, that's so weird. So, correct me if I'm wrong, but partially... a diabetic foot checkup but some issues with some other issues. Yeah, that's really why I told Dr. Edward, I had one injury in the Marine Corps jumping out of a vehicle and then a week later fast-broken out of a helicopter. They said, because I landed on a rock, you plantar fasciitis. They gave me a tennis ball and some medicines. I got through it probably six months, it stopped turning completely. That was 30 years ago. But now, just like at Camp Bend, I've got a rod from here down to my ankle, a second is this lump right here and I think it's building fluid to protect something but I don't know if there's a fracture but I don't think so. The more I play with it and watch when I move it, it looks like there's a tendon right by the shark's head and fin. I don't know if anything goes like that but I retired this year and then she sent me back after a couple weeks. The wagon was after 31 years because they sent a letter, we need help. I'm like, no, next time on the ladder. And so after like an eight hour day, that top of that foot hurts. And I think the other thing is I feel it like a callus, but just not really a callus. I got a numbness here. It's not pain. Yeah, but I thought diabetes wasn't easy to cut your toes off. My toes are fine. Both out steps. The blisters you see, I just got them on Saturday from a new pair of Birkenstocks. I wear Birkenstocks religiously. Shoot, I probably have four pair. She got me a new pair. to match another outfit. And the first time I wore them, I got blisters. I put them up for a month, wore them with socks. That's fine. I wore them again. So, she's going to take them back. I think the bed in it must be formed different than all of them because I've never gotten blisters. And Saturday at the public market, just walking around both insteps, I came home and I had a problem and I soaked them. But they were raw for a couple days, but they don't grow now. Okay. Gotcha. But at least you know what they were from and know what. what caused them. And so you're telling me about that you get some numbness on the outside. Almost like it's a callus and that's where I go, I get pedicures once a month. Don't judge me. But if the grandkids around, yeah, I get my children on spain, my granddaughters. But I go and I soak my feet a couple times a week just to see, I know Epson salt doesn't do anything but that or a bath bomb and that. I scraped this foot with a cheese grater. The reason I'm peeling so much is she just ended up, she got these booty foot wraps you put on and they soften out all your stuff and all that. And then for like two or three days I'll peel. But I can never work on this foot because I can't bend it more than that. They've told the five surgeries on this leg now since I've been recording for a month. Gotcha. You get any burning or tingling in the feet? Every now and then I will say that my toe. and then it scares me and I put the cookies away. Okay. But I don't know if that really is probably where it's from. Well, the sugars can affect the nerve endings, yeah. And I'll test those and this doesn't hurt. I just want to know if you feel it. I feel it. Not as much. Yes. Yep. Yep. I feel this pressure. You know something's touching. So, what we know from the standpoint of having a diabetic foot issue like an ulcer or a wound, if you can feel that it's very low that anything's going to happen because you're going to feel the pain from whatever's harming you and stuff. The people who can't feel that are... ones that get into trouble. Because they don't know. He says I'm having a heart attack. I went, I'm pending, I'm detached by a shot and two torn rotators on this side. And I had neck surgery because this arm didn't work and I didn't understand it. But the minute, it was like a kink guard nose. The minute they did the surgery, the next day I moved my arm. So, it was something pinched, I guess. And they said it's happening again. So, I went to sort of work up for all these surgeries and they wouldn't do it because my A1C was better. So, he put me on rubels. I don't test regularly, he doesn't have me testing regularly. I don't do, my brother has to give himself insulin or something. I don't do any of that. I've lost 30 pounds in nine months and he says that's because of the rubelluses. I'm still eating pizza and cookies. If I really worked on it, I think it could be better. But you're getting there in the literature as long as you're going in the right direction. But the grandkids just avoid it today. Never been there. It's a cookie shop right off the road. Italian pastry and stuff. Oh yeah. Don't tell me those things. I live right around the corner. Can you push me? Good. This one. Good. Yeah, you got it. Any weakness or anything? No. No? Okay. Any issues with cramps and the legs when you're walking that make you stop walking? No. Leg cramps and trolley horses when I don't drink enough and then I over-insert myself of meaning. We hunt a lot and do a lot of walking. When you're drinking beers and stuff, you don't have to come home at night and not get enough and walking around the bedroom and say, I got to turn on your horses. But that's just because you're not drinking enough water. You gotcha. Yeah. And this, so what you've got here is how we can take an x-ray to confirm some of the other things as well. But you, you've, I can feel some spurring under there. So you, you definitely have some arthritis in this joint here. Oh, there's a joint there. Yeah. I didn't like you were mentioning. I get like a liquid bubble, but nothing like a blister you think you can pop. It's way under his skin. I'll call it a bursitis where you get this inflammatory fluid sac that responds secondary to the arthritis. And I go away, and the last thing was on this foot. I thought he would send me to a... What's a skin doctor? A dermatologist. A dermatologist. It's not a wart, I don't think. But unfortunately it's right where all my... my shoes cup and it rubs and it gets irritated. Then my wife took the cheese grater for your feet and she says, well here, and she started scraping it, but then it just started bleeding. So I don't, I don't think it's a skin tag. I don't know what that little lump is, but it's not painful. It's painful when it rubs. It's irritating because all my shoes rub, rub, rub, and even my Percocet straps go around and these are not good for my feet. We can do a little procedure and cut it out if I bother to. Yeah, three years now it's freaking annoying. Yeah, I would love that. Yeah, well are you swimming in the summer or anything? My brother's pool with the grandkids but I don't get it. I don't have to get in. Okay, yeah. Or my swimsuit while we're at the cottage. Alright, yeah, we'll have it scheduled. In the office just now. What would you call that? Yeah, so it could be a wart, but it doesn't have that exact appearance that you would expect. It hasn't gotten bigger. It just appeared and then that's the next I want to say, a couple years now. Yeah, I'm guessing it, so we'll send it to the pathologist, but I'm guessing we'll call it a dermatofibroma, which is a benign skin lesion. If I know what working shovel is in a row, I put a bandaid on it. just so I can wear my work shoes because we have to wear specific non-slip shoes. That means that they give us every six months, we get a free pair of shoes, but they're the worst. There's no arches at home or anything. I used to buy Dr. Seuss. You stood on a machine at Walmart and you calculate what you need. I thought I felt they helped, but they're expensive and I stopped buying. Well, we could go because... Typically, with a history of diabetes, most insurances will cover orthotics or inserts. If you want, I can get you set up. That would be awesome. Yeah, let me, I'll put the order in right now. So the U of R, they'll actually get a hold of you, but we'll give you their information. They have a lab, orthotics and prosthetics, where they'll make a mold and make an insert for you. I know, I should go to the quick feed store. You should go there. Well, I'm sure it takes it and then you just don't. Right. I buy some of it when it's off the shelf. My foots hurt and I didn't go to the bathroom and put them in but they don't last. Yep. They may help but they do break down quickly. Yeah. Note will get you I can click the right button and be all set. Yeah, she intercepted the letter from Vytman's Hasky to come back for the holidays. We can't find people who work here, nobody wants to work. You're going to shred that all up in your pocket. I called them and said, you know, and I put in a bunch of my retirement package stuff and she went through it and found the letter. Just, are you going to go back? I said, no, I told them, next day she says, you need to go back. We sat on the couch and plus she works from home. So she's in a lot of debt. My days off are like, what are you going to do today? What are you going to accomplish? What's on your agenda? I'm not seeing a sneak trip. Get along. She's not a fan of that. She's been here for years. So, um, do you, so we could do more with this if you want meeting. Um, we could get. you you It sounds like we'll see each other again." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm sorry to hear that. Now, did you grow up here or are you from Florida? I've been in the area since the 60s. Gotcha. And obviously still people down there. Yes. Okay. Well, what's going on with the feet? I don't know. I started out with a gallon in my big toe. In the... Okay. And then I got on the upper ventricle and I used 100% tardure juice. Okay. That works. But then I started back here. Boy, thank you. Yeah, and then it would swell when I walk around. It swells like a pig's. More on the side, the outside over here? Oh, yes it would swell. I need that. Gotcha. Just on the left side? Yeah, the other one tickles, but it doesn't swell. It doesn't swell. Okay. And when did that, not the gout part, but when did this start? After I got sit down. I looked a little more than just like now but I was fine when I went to bed. I didn't know what I wanted. I couldn't walk. Okay. Is it seem to be getting better or is it the same? Yes, the same. The same. Yeah. Do you get any weakness? Do you feel like it's going to give out? No. Am I hurting? Yes, it needs to know that's not going to do. Please. Can you push against me? Maybe this will turn to you. Still? A little bit, yes. About down on your head. Right there too. Yes. It's right there. Sure. Yeah. Yeah. How about the ankle bone? So? Yes. Yeah. Cool. Well, let me have Crystal get a couple pictures of the ankle bone, a couple x-rays, and see if anything's going on there. Yeah, we certainly have a few areas that hurt, huh? Thank you." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 44 year old male patient presenting for CT review and follow up of a left knee pain that started on 2-17-24 after being hit by a car. Patient was sent for CT due to concern for a non-displaced patellar fracture at the initial visit period. Patient was placed. in a knee immobilizer which he states has caused additional knee discomfort as he is applying pressure over the patella itself period. Patient otherwise states that he has been mostly maintaining in the knee immobilizer and has avoided bending of the knee period. Please copy over to prior left knee exam. Assessment plan, this is a 44 year old male patient presenting for CT review and follow up of a left knee pain after being hit by a car on 2 slash 17 slash 24 period. Patient was sent for CT due to concern for a non-displaced patellar fracture at the initial visit period. Review his CT today W- The potency of the lateral patella facet that is suspicious for a nondisplaced fracture. Period. Patient on repeat examination today continues to exhibit. Exquisite tendons palpation to the lateral side of the patella. Period. Discuss patient that given the exam and. the area of lucency that is suspicious for fracture, we'll treat this conservatively and we'll continue to place patient in a, transition patient to a post-op brace, knee brace, with extension locked at zero. period. Patient advised to continue to maintain in the brace for additional three weeks at which point he'll come back for a repeating examination period. If he no longer has any pain without patient, at that point, we made this continue to brace period. In the meantime, we also provide a patient with a physical therapy referral as well so that he can start physical therapy. to get out of the brace period. We'll see him back in three weeks for a repeated examination. An x-rays period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "Hello, hello Thank you for waiting for me you're tired You didn't sleep well as now what happened You were just awake yes When they give you chemo they give you lots of things to prevent nausea vomiting and sometimes that kind of energizes you and yes And you don't sleep well When you're not sleeping well, you can doYes, I did do it last night, correct. I didn't take it, but definitely tonight. So today we're going to review the whole situation and where we're going to go from here. So of course, you know, we have positive results. We're going the right direction. I know, I know. The pain you were having is a little bit better? No, nothing. Eating? No problem. And you haven't been bleeding anymore? No. The blood maintaining, 11. Yeah. 10, 8, 11, 10, so good. Back pain is gone after the first chemo. No more back pain.So the baseline is that we have a tumor that goes from the esophagus down the line in the stomach into the pancreas. And in the tail of the pancreas there is a tumor. I don't believe that it went from the pancreas to the stomach and got all the way to the esophagus. I think it's the other way. It went from the esophagus down into the pancreas. And I say that because you've been having gastrointestinal bleedings and symptoms for almost two years.Pancreatic cancer doesn't do that. Pancreatic cancer, you don't get treatment, you die in six months. It's not pancreatic cancer without treatment. With treatment, we can make people live longer. And then the biopsy showed a carcinoma with squamous differentiation. Squamous means this tissue that looks like your throat or your larynx or your skin. The esophagus can have squamous differentiation. All the cancers can have squamous differentiation, but not very common. So I believethat because of these two years of gastrointestinal symptoms, things were born between the esophagus and the stomach. I think I've just been spreading it down, giving you discomfort when you eat and causing the bleeding. So I'm giving you a treatment for that. And you're responding, right? Everything is smaller. So when we met you, there were some lesions in the pelvic bone, not clear if there were cancer or not. Doubtful significance. We didn't biopsy that. But right now there's no activity there.But there's no cancer activity there. We're never going to know if there was cancer there or not. Or it's better. On the liver? Not on the liver. This is on the bone, the pelvic bone. Oh, wow. Now, when T8 and T9 are the spinal bones, there is also some hypercalcification of the bone that can be due to cancer. But there is no metabolic activity there. And I don't know this because you're taking chemo and immunotherapy, but there is nothing there. And we'll never find out if that was cancer or not.will make you stage 4 now in the liver there is solution for this lesion in the liver is not growing and let me see this November ultrasound that they know that's not you I'm sorry so in the liver there is something but I don't know in the liver that is malignant or not but there is more more likely to be malignant because the lesion in the liver is metabolically active on the PET scan we measuredmetabolic activity, not just measure the size of the tumors. Why? Because the contrast on the PET scan is sugar that is radioactive and is absorbed by cancer, making it light up like malignancy. So in the liver, it may be that there is tumor in the liver, which is not surprising because from the esophagus to the pancreas to all the bowels, all the circulation goes to the liver.we can find cancer that spread to the liver but I'm not I'm not 100% sure that what we see in the liver is malignancy and nothing that I'm saying is new we talked about this liver thing from baseline the CT scan and the PET scan if I was looking at them correctly don't they both show that lesion and the liver is being the same size the 1.5 cm correct so this liverthing is not shrinking so it may not be malignant it's everything else is shrinking except that and they i think the word they used was stable on that yeah and and the metabolic activities there for the size of this didn't change so only time will tell what you have so if i make it so we need to continue this treatment right so that's the time continue this treatment you also feel better all right so if i was going to make a picture of the bodyyou have your chest with lungs and everything looks great nothing in the lungs nothing in the lymph nodes in this area so this is all good because you have esophagus and the stomach and we do see malignancy from here to this area and then behind the stomach there is the pancreas and then these tumors are longitudinalhave a tumor there in the pancreas so what i wrote here is actually in this area right there and in the liver there is this tiny little thing that we don't know what it is has metabolic activity level three let me show the metabolic activity in the stomach and in the pancreas so that we can see the differenceyou see the real cancer has metabolic activity of level six and level five so metabolic activity is the amount of absorption so what we know that you have cancer here and here this the metabolic activity we call it SUV is level five here here is level three and thisis stable so I don't know where this is cancer in the liver because I wasn't sure what that SUV stood for that's a metabolic activity normal is one to two point five so this three is very questionable so in the spinal bones well behind everything actually is more higher of there there's like a little bone a finding but I don't think it's cancerAnd then in the pelvic bones here, there are some sclerotic lesions, but they're also questionable. They have zero metabolic activity. So the only place I can be sure there is cancer is in the esophagus, in the stomach, spreading into here. So the pancreas, the stomach, and the esophagus. And it's all one big tumor all together. Yes. It's one side.Here, I'm 100% sure that it's malignant because we have a biopsy and because the SUV is high and because she's shrinking with tumors. So this in the liver, we'll keep observing it because once we do radiation, I would like to, maybe we decide to radiate that. The bones, we're going to leave them alone and we're going to think that hopefully it's not cancer, but we don't know. But we're going toyou're going to the immunotherapy chemotherapy goes everywhere someone will give you more chemotherapy four more sessions and after four more sessions of this we're going to do another pet ct if your insurance allows otherwise we're going to get a ct scan or maybe i'm just going to get a ct scan will be easier we'll just do a ct scan now four more treatments and then a ct scanThis is the only place that we know you have cancer. The rest we don't know, we don't know, we don't know. Come on in. Sorry to interrupt but... I don't know about the show, excuse me. Are you clear on what he's saying so far? Okay. I don't like it, he said let it fly. No, let me tell you something. Let it fly. Listen to me. Everything he said so far is good unless someone saw. Okay? What he's talking about...four more treatments of this chemotherapy immunotherapy that is working and after that if things look positive then I'm gonna send you to a radiation doctor after the formal treatments so I have one of the hospital 31st the 14th before no but not aftertreatments from the beginning four more treatments from now yes yes because up to now I did four this is my fourth one today but his third one with you yes what I'm saying is that your CAT scan was done before the 28th right yes okay four treatments from there so 228 March 3rd March 13th I need to um are you counting the one in the hospital or just the one I'm not counting the total number of treatments I'm saying four treatments since the PET scan you'reBecause I don't care what happened in the past. What happened in the past, we already know. Your work is shrinking. I don't care how many you got in the past because we already know that whatever you got is working. Right? From now, we got the 28, the 13, the 27, and April 10. After those four, we're going to do another catch-up. And if things keep going our way, which they will, shrinking, I'm going to send you to a radiation doctor. Right? And I'm going to ask the radiationdoctor to consider giving radiation to all these area that's fine the liver and the others but the liver I don't know not only the bones no I don't know it was cancer or not and if it was cancer we don't need radiation anywhere so what do you need to ignore the bones the liver I don't think it's cancer what we can give you radiation there the radiation is called stereotactic body radio surgery so this type of radiation SVRT is not a body radiotherapy this typeof radiation called sbrt is as good as surgery how come i don't send you for surgery because it will make you miserable we have to remove your esophagus your stomach your small bowel your liver and we can do surgery for something we don't know we're going to cure it but radiation can be quite curative so hopefully the radiation doctors will think like me positively that everything is in one field that you don't have distant metastasis and we go for radiation and i want them to give you a curative doses of radiation of course it's going to be veryoff or you can take it off if we cannot get good results right so that's what we have your diagnosis to me is a esophageal gastric squamous carcinoma that had directly invaded into the pancreas yes they're attached and it's the same tumor they're attached you're on this chemotherapy immunotherapy there's a very aggressive chemotherapy you're taking for 40 noxious very aggressive and it's working and then you're goingradiation and hopefully we'll get a response we're gonna get long-term results and that's what we're going for so after the full time you want to do the CT scan and before you do radiation the CT scan will tell you if we need to do radiation or CAT if the CAT scan shows everything is shrinking and there's nothing anywhere else and shows that the liver is nothing then we're gonna go to radiation I don't see the radiation now because they can't do anything right now rightActually, it's very likely that the radiation doctor will say, you know what? Things are going well. Continue radiating. Continue chemoimmunotherapy. Up to 12 treatments. 12 treatments total. Now we're talking total. Right now we're just talking four, starting February 28th. Right? And the 28th was actually the third treatment. Practically, the SPECT scan is like the baseline that we were talking about from the beginning. I didn't do it right away because I just wanted to get the own treatment, and withSo maybe that radiation will want you to do 12 treatments before they do radiation. So he will tell you, the guy that you're going to talk to, he will decide if it's... He will decide if he does radiation then or later. I think the most likely thing, he's going to want to wait longer. So practically, I envision that you're going to keep doing chemotherapy with this immunotherapy all to 12 treatments. After 12 treatments, actually, after... You're going to do these four. After four more,I'm going to do another PET scan. And once we see that there is almost nothing or nothing, then we're going to do radiation. Now, radiation versus chemo, I don't know what's the difference. Chemotherapy is a substance that you get intravenously. The substance is toxic. It doesn't let the cells produce protein. It doesn't let the cells produce DNA. And the cells that are trying to divide like cancer die. That's why we also damage some of your normal cells. The blood cells grow a lot.and we kill them too that's why your blood can't come down they come back up on chemo radiation is like this this is radiation except that it is radiation doesn't bounce doesn't go through your skin it bounces out that's why my head is shining from the light hitting me radiation is a type of light that your eyes don't see that has a narrow wavelength and this light and it crosses the skin and burns the tissue inside so SBRT what they do is to be readythat this is your tumor they will they direct these laser-like beams all around you into the area where the tumors are radiation is a physical treatment to attack cancer it's a physical treatment because this x-ray radioactive things that will go in there right why because one radiation can be toxic in this area soThey're going to go for curative radiation. They want to make sure they don't hurt you for something that is not curable. Number two, because the smaller we get the tumors, the easier the radiation will be and the less radiation they will give you. So the chemo will reduce the tumor first and then radiation will finish. Yes. Also, they want to see that the chemotherapy is working more than where we are. So if you look at the CT scan from the first time on the 12th,that at the pancreas was like 8.1 centimeters and now we go to 7. It's a good percentage? Yeah. Okay, it's good. I think it's much better than going from 8 to 7 because your tumor is not like a mass like that. What they call 8 centimeters is like thickness from the cervical down to the stomach into the pancreas. So it's not like a softball of centimeters. It's a longitudinal narrow thing. Okay, so the 8.1 was all together, not only in the pancreas. It was total.H1 is a very long tumor. They're not measuring even the thickness of it. I know it's narrowing too. But I went to seven, so it's good. Yeah. Even if I repeat an endoscopy like with Dr. Kohlkland and take biopsies again, he may find nothing. But regardless, I think we need to do radiation. Oh, you do. Radiation is for sure. I would like to do radiation. Now, is it indicated? If we do things standard, I can call you stage four disease. Cancer that went to the pancreas, in the liver, in the bones.you will be non-curable. But I don't want to consider that because we don't know for sure. I want to consider that your cancer is limited to the esophagus and the stomach and go for the cure with this chemo, immunotherapy and radiation. And maybe we'll give you radiation that is not going to be helpful because the cancer was already in the liver and the bones. But without 100% evidence of that, it's better to treat you like if you only have cancer limited to this place. Do you understand? I want to treat you formiracle that maybe we can cure you and we're going well in that direction see what I'm saying yeah but yeah it just yeah I understand what you're saying until Wednesday he had no idea that he would still be in chemo for six months so it's I think understanding that his process is going to be a long so you thought you were going to do few chemo and then be done no no no I was thinking I will do the chemo and then after you do the CT scan you continue originally in the hospital you told me sixmonths for sure you told me this the first time I saw you yeah six months for sure we're only a month or six weeks yeah yeah you have long time to go but keep in mind that you have a malignancy that what is that could you tell him what the word malignancy means cancer you have cancer and remember that cancer is cancer that's why you've been upset and sad because it's cancer now this cancer we're doing well with the treatment and I'm hopeful that maywe can cure it by doing this. But I'm trying to explain that all this that I'm saying that can happen, it may not be true because the cancer maybe went to the liver, maybe went to the bones. So maybe you are not curable. Remember my little cartoon? I said I'm going to consider the cancer was limited just to this place. But maybe I'm wrong. Maybe it is in the liver. Maybe it is in the bones. And that will make you non-curable. But we are not sure of that. So how will we find out? Well, so far the PET scan shows nothing. So far thesuggested the reason we're gonna go with videos because I don't think it's cancer but we're not sure I don't think it's cancer in the bone or the liver in the stomach for sure so I'm gonna explain to you again and make it big this is your esophagus that connects with the stomach there's cancer in the esophagus that's spreading tostomach and this is what they measure eight centimeters I gotcha and this and the pancreas is behind the stomach so this cancer went through the wall of the puff stomach into the pancreas making a tumor here okay and if you have pancreatic cancer then we're not in a good place because pancreatic cancer we can cure when it's like that but I don't think I pancreatic cancer I think you have gastroesophageal cancer that's pregnant to the pancreas that's clear I meanthat from day one. Now, if the cancer is limited to here, that's what I think or what I would love for you to have. That's why we're giving chemo and then we're going to give radiation to here. Now, there are some unknowns that here there is a liver. Yes. And in the liver you have a lesion here that I don't know what it is. I don't think it's cancer because the metabolic activity, the SUV is not there and because this is not shrinking. And then down here in your bone,this is the bone you also have something in there that may be cancer you don't want to tell me that in the phone i just don't know that it's cancer so because i don't know if it's cancer and right now there's no suv i don't think it's cancer but i'm not sure i'm not sure i'm not sure and because i'm not sure i'm going to go for the cure with what we have in here why not radiation now because we need to wait longer for the immunotherapy and chemotherapy to declare itself i want to make sure that this is nothing and this is nothing i want to make this smallerSo you made the treatment more easier for you. What about the spleen? The spleen is the same. There's nothing in the spleen. Maybe there was cancer. Because the spleen is right here in the same place. Yes. So this tumor of the pancreas went into the tail of the pancreas and into the spleen. It's all one tumor. It's all one big tumor. And it was one big aggressive tumor. It sounded like just busted its way. Well, it's not that aggressive. It took two years to do this. Exactly.It's not that aggressive. It took two years to do this. So I was bleeding because of that. You were bleeding because of that. Two questions that I have for you. On the PET scan, on the PET scan, in the first portion of that, when it goes under findings, it talked about when the contrast went into it was intense activity in the brain. What does that mean? Intense activity in the brain? It means that he's thinking. It means that he's acting. That's what I said.everybody it was talking about listen the fdg or the whatever the brain the pet scan is not a good brain scan because the brain looks like a giant tumor with high suv okay like level 20 compared to level five or eight right so when they use the word intense i was like wow well that's normal that means that his brain is working it must be normal because then in the findings it didn't list anything they meant that people have low activity in the brain he's nothis brain is working great all right my last question for you is the compassing that they are giving him for nausea is working great for nausea unfortunately it makes him manic is there something else that he can take like well give him something he was his own episode for on Dan Cetron okay and that's the so Fran so sure give yourselfI understood Marty correctly. She said we couldn't use Zofran with this type of chemo he's having. Do you have Zofran? Yes. Take Zofran. You can take Zofran. I'm not sure that we do. Can we get a prescription for Zofran? Thank you. You ripped the label off. I don't know what's the communication, miscommunication. You can take Zofran. Thank you. And you have it. That's why they prescribe it to you. I'm just going to refill it. Thank you. They prescribe it to you because, yes, you can take it. Thank you.Now you can try compassing too and relax him with something else, you know, buy him some CBD. Buy him some gummies with CBD. Give him compassing with some CBD. CBD. CBD. Just buy some CBD oil, put it under your tongue and relax. Don't make him high with THC. Find pure CBD. They sell it over the counter. It just relaxes you. Okay.I used to have in my drawer a lot of CBD because I used to make CBD. But I don't have it anymore. I ran out. I just give it for free. One question for you. If you look at my cancer, it go by stage, correct? Stage one, two, three, four. Cancer. Yeah, what I am. Well, you have at least stage three. If we ignore the liver and the bone. If the liver is cancer and the bone is liver, you have stage four. Actually, we should call it stage four, butYou understand everything we've been talking about? Yes. I don't know that you have stage four because we don't know. I'm treating you like if you have stage three. I got you. Period. Okay. But reality, so many points are gone. I mean, say, you have stage four. But this stage four, we're going to go for the cure. Okay? Can it happen? Yes. Are you going to suffer through treatment? Well, you already know it. Yes. Okay? Yes.Three minutes working? Yes. Do you feel better? Yes. Are we going to be able to do that radiation, SBRT, that can cure you? Yeah, we're going to go to that. So what you need to do when I leave the door, you need to say, that doctor is going to cure me and the health plan is going to be okay because your mind helps. You cannot be worried. Positive mind, positive body, positive results. Yes.You need to be convinced that we're gonna go for the miracle And if these doctors why right it will find another one to radiate you so we're gonna go for the cure Your chemo is working and the chemo is working Right. So just because you I have to give all the information I need to discuss to you the bone and the liver and this and that I have to call it stage fourbut that's not what we're doing just remember I said we're gonna just consider just all one to one in one side whatever is outside we don't know what it is we're gonna ignore it we're gonna go for the cure and that's what we're gonna do so you go on walks you have fun you enjoy meals you have very well balanced diet have fun go to the movies go for a hike go do whatever you want to do to have fun and you mentallyNeed to meditate and know that you want to be cured. Yeah, I'm positive on that I mean you did already something you are the present stress the immune system is not gonna work Do you want the optimum you know say to work you cannot be stressed. It's very well Scientifically proven that people with stress and depression they develop cancer and viruses and shingles and all that You cannot allow yourself and you're going to some cave of oh my god. I have cash Snap out of it. You are you're gonna be curedyour children and your lover, wife, girlfriend in seven years. Oh my God, we got cured. And it's not me. I'm giving you drugs that I didn't make up. You're taking great drugs and you're going to do the radiation. And the doctors want to see you are great radiation doctors. And we'll see what they say. You don't do radiation? I don't do radiation. But there are great radiation doctors. They're going to work with us to get it done. But I'll be with you for 12 more times. I'll be with you for a while. You're going to do four more and then we'll decide. No.I think they're going to want to do more. We'll see. Okay, that's fine. Because the only appointment I have is the 13th. And after that, I'm sure they're going to tell me to come after. Yes, they are. Yeah, so I'm okay. So you get the 13th, the 22nd, and then whatever it is in April. Yeah, yeah, yeah. So I'm good with that. You're going to be doing great. I'm treating you more aggressively than normal. I know, you told me. But I'm okay with that. Because normal would be to give you just something called float or fall form. I'm giving you fall form, which is the drug that is more aggressive. But...You'll see that when we do a PET scan next time, things are going to look great. He's cool with it. Right? First it's going to be a CAT scan after four treatments and then four more and then a PET. And that PET is going to look wonderful. Thank you. I appreciate it. Thank you for all the work you're doing. I'm not allowed to go into a bath. You are going to go through this miracle. I'm taking positive. Yes. Definitely. Thank you. Very good. I appreciate it. Thank you very much.Thank you.so they follow meAll right.Thank you.coming in room 20 and then 18 I thought I was on to 18 first because of our blood pressure who is first 20 was first I want to go to 20 yeah okayAll right.All right.All right.What?Oh no, your chair.E aí" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " presents the primary concern of right foot and ankle pain. She notes after last visit, she had a flare of pain and had difficulty walking. Notes that she could barely go up and down stairs and had to go up on her hands and knees. She was seen by both her primary care physician and by Dr. Katz. Period. This was thought to be associated with midfoot arthritis and posterior tibial tendon dysfunction. She was offered bracing. and anti-inflammatory medication as well as potential surgical intervention. At this point she then started taking turmeric, which did seem to help, and is now questioning whether she should consider surgical intervention. She knows she is able to walk better and is able to use stairs without difficulty and not feel she needs a brace or orthotic at this point. Diabetic peripheral neuropathy. She was taking gabapentin, 200 mg TID exam. 1-4-6 cells are supposed to be atypical pulse to both feet. Sounds like supertactical pulsations are detected. 5-5 test is passed to both feet. There is thickening with edema through the left, excuse me, through the right midfoot, essentially to the vehicular cuneiform and listerine joint area. area. There is decreased muscle strength testing for plantar flexion and inversion. The skin is intact to both the ulceration or infection. Personal interpretation of radiographs of the right foot from 10-24-23 demonstrate midfoot degenerative changes, no fracture. Assessment was here to move into function for arthritis plan since she is doing well with. have recommended she continue with this course, bracing as needed. She inquires about surgery and reviewed that this is a quite significant procedure with lengthy recovery and she at this point does not believe that this is warranted to diabetic neuropathy, continue with the up-ended and reviewed diabetic foot precautions followed for high-risk diabetic foot care." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 32 year old male presenting today for follow up of a right ankle sprain that occurred on 9-23. 2023 patient states that he's been making progress with physical therapy in some aspects and at this point has completed eight weeks. He notes he has returned back to high impact activity like running without issue. However, every time he plantar flexes his ankle while weight bearing or non-weight bearing, he gets pain in the posterior aspect of his ankle. This was improving initially but this seems to have plateaued and he's disappointed that he's continuing to have symptoms this far out from injury. Please add a normal ankle examination and state that there is pain elicited with plantar flexion. First assessment is a 32 year old male presenting today for follow up regarding a right ankle sprain that occurred on 9-23-20-23. He has now completed eight weeks of physical therapy and has been able to return back to high impact activity but notes that he's had a plateau and improvement in the pain in the posterior aspect of the ankle. Based on symptomology, I'm suspicious he's experiencing Ostrigonum Syndrome. I would like to order an MRI to evaluate for this and rule out any other underlying injuries he's going to follow up once MRI is complete please send a right ankle MRI without contrast to evaluate for Ostrich Gonan syndrome this is going to go to IASM" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Who presents today for repeat evaluation of her left elbow. She has an MRI showing recurrence of some lateral epicondylitis. She has status post surgery on this elbow many years prior, but now with recurrence of pain. She comes in today for cortisone injection. We discussed at her last appointment conservative management and cortisone versus PRP. Period new paragraph on examination today. Please insert left elbow exam. Please add tender to palpation over the lateral epicondyle and pain with resisted wrist extension. Please insert right elbow and please add medial tenderness palpation over the medial epicondyle. Period new paragraph assessment and plan. This is a 65 year old female with long standing left lateral epicondylitis. left side is far more symptomatic than the right. We will proceed with a lateral epicondylitis injection to the left elbow today. I'm also going to give her a prescription for physical therapy for both her left lateral epicondylitis as well as her right medial epicondylitis. We will see her back in six weeks for re-evaluation." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "you\n[DICTATION START]\nAn impression plan primary myelofibrosis, jack to mutation positive. Charlie is seen in causing for further valvular primary myeloproliferative disorder. He's known to be on inrabic, which he's been taking for the last couple of years without any major side effects. This has relatively kept his blood counts under control, with the exception of some minimal fatigue. For the most part, his numbers are stable. Today, for the first time, his WPC has been higher. Now, close above 20,000. It's been a very long time. Again, he's otherwise tolerating it well.His numbers continue to be high. At that time, potentially, we'll consider doing a bone marrow biopsy period. He's never had hydria. Maybe we can add hydria to his regimen to try and bring his white count more closer to goal. If needed, we can switch him to an alternative agent as well. Again, we'll discuss the same in six weeks and make a determination at that point. Fortunately, from a breast cancer standpoint, he's doing really well.\n[DICTATION END]\n" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Unfortunately, I didn't hit the record button for Ms. Forceman, so I'll dictate from memory. She is six months post left rotator cuff repair period. She's been attending physical therapy in Reno where she now resides period. She appears to progress nicely in terms of forward flexion and abduction, but it does have significant limitations in terms of rotation period. In the current and present examination range of motion testing of... the shoulders revealed open parenthesis right slash post-operative left closed parentheses forward flexion to 175 degrees slash 165 degrees comma a deduction of 175 degrees slash 170 degrees comma extra rotation of 70 degrees slash 40 degrees comma push the interpretation of t10 slash L4, period, and paragraph. We had an extended discussion regarding treatment options or treatment slash evaluation options, period. As she doesn't reside here, I did offer to do a cortisone injection to treat possible adhesive capsulitis, but presently she was disinclined from this and I suggested that perhaps you try an oral course of prednisone, initially 20 milligrams for one day, then 20 milligrams daily for a week. followed by five milligrams daily for a week. Piran, she will get an MRI scan of 1.5-3 Tesla at least closed parentheses upon her return to Reno and those studies and the report should be forwarded to me. Piran. She may benefit from a corticosteroid injection if she appears to have adhesive capsulitis. She also understands the possibility of requiring arthroscopic debridement, but this should wait until we've pursued the other measures. Perot and dictation." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " What's going on? All I know is that I'm in pain. Yeah, where? I don't know what I did, how I did it. Remember I sent you a message that I was in pain, but it was just this that hurt. And it was tight. Yes, okay. But this is going this way, this way, and this way. Like a distal femur. into the mid, thigh up through the groin. Yeah. Make it a big like C shape. And then sitting on the toilet? Yeah. Or sitting on something even hard like this chair. Yeah. It's like there's one point back here. Can you feel it or no? There's nothing there or? I don't know. I can't feel anything. Okay. Yeah. And how long has it been going on? Since you messaged me, I can't remember exactly. The details of that one. Yeah. Okay. Since I messaged you, but it wasn't this bad. I mean, I could take a cup of Tylenol, I could live with it. Mm-hmm. But this doesn't... ...want to... ...ease up. Okay. Any swelling or bruising? Okay. Don't know. And no fall. No new fall. No new fall. I just fell that one time. Okay. Let me go back and see when that was. It wasn't that. It was before your appointment with Dr. McDowell, correct? Yeah. Am I wrong? That's why I came to see Dr. McDowell. Yeah, and what did she say? She had me do an x-ray. She was very busy that day. But I was, it was like more reassuring that nothing was loose or out of place or unattached I want to say. Yeah. That's what I was kind of worried about but the pain isn't going away. Right and you haven't tried any new physical therapy exercises? No. they've been working on the same stuff. Did you get into a new therapist? No, not yet because I haven't found one. I don't know which one. I don't know if I want to come out all the way out here. Is that where we have it? I think so. I think so too. But I mean I have everybody the therapist said the PT said performance therapy is the same as going to regular PT. but everything that I've read it's gonna make supposedly makes me more functionable. Okay. And you said it would make me more movable. Which is function. Which is function. Mm-hmm. So I I haven't really looked and I got kind of busy with Christmas. Yeah. But you haven't changed is the main thing like you've been. Yeah I've been going to the same PT. I'm trying to pull up McDowell's. You saw her on the 11th. That was Monday? Last Monday? Yeah. Okay. So, what I'm thinking in my head, of course, is, you know, is it just scar tissue, right? That's what my... My first thought is maybe it's scar tissue or something. I thought scar tissue and then I thought well maybe the antibiotics aren't strong enough. It could be another infection and I'm trying not to let my brain go there. Right. You have a CT of the left femur. Yeah. Ordered when? One set, 17. So a month from now. So that's ordered. So I think the CT will tell us if there's any evidence of infection. I could have gotten that for you. No, I needed to get it home. I figured you needed to stretch so I didn't see anything. I could have gotten a tissue. It just hurts all the time. Yeah. It feels so swollen and heavy. How are we on the front of like the swelling on your feet and ankles? I've been putting magnesium stuff on and it's that my ankle is still swollen. Yeah. It still looks like a cankle. Yeah. But it doesn't hurt as bad. I bought decent sneakers but it hurts like right on the lateral border. On that border, yeah. But at least I'm moving a little better with the exception of... And you're done with plastics, right? Yeah. You don't need to go. I do have an appointment. You do? Ooh, are you going to go? Yes. Okay. But I don't know what I'm actually going to say to him. So this is what I was actually wondering. If you could ask him if it could possibly be... the scar tissue But what will they do? I mean Will he go in there's anything to be done? I think what he would do is probably wait for that CT scan to make sure there's no evidence of infection Are you still getting lab work and things like that from infectious disease? Okay, so that would be the first sign right that would be our cue to that something's going on and those have all been normal Yeah, right. Oh, there's no elevation Those infectious no markers in their way The only elevation was inflammation at the time I had, which was three months ago, was inflammation and Dr. Victor said something else. Yeah. And when's your next lab scheduled for? Do you have a scheduled timeframe? A week before I go for, a week before I go to. Infectious disease. So between Christmas and New Year's you should go and get them. Okay. Because that's my first thing I would like to know. Labs, make sure there's nothing going on. The CT to make sure there's nothing going on. And then third, my guess would be scar tissue and pulling of the muscles. I want to look at your skin though. If it's scar tissue. I don't know what the answer would be. Okay. Like what to do. what could be done yeah I don't know if that would be just a simple or a complex or what it would be worth or if we just hold out and wait to see if things calm down okay because it doesn't feel like it's calming down no I know at this point it doesn't I mean even my incision hurts mm-hmm you know it just burns okay do you what do you take my rub it and I massaged it mm-hmm and I did what Pete you're on the Lyrica You're on Lyrica? I'm on Lyrica. Okay. I am, they put me on sertiline. Sertiline. Sertiline. Okay. Because I was crying all the time. Yeah. Did that help? Still crying? Yeah. I'm not crying but it's better. The tears, they just stopped the tears. It didn't stop. Yes. And PT would say, Paula you gotta stop. was like motion. The more I made a headway, the more I would cry. And the harder I would cry. And then all of a sudden this. And it's like I'm back to this. My cane doesn't even seem to want to help me. My purple cane. I'm just going to put this down on your chair. I'm going to have you stand up and just your pants down. I don't need that. No I was gonna put it on your chair in case you needed to sit back down for a minute. Oh okay. I could stand. Did. Oh I was gonna say we did get the x-ray. I just want to make sure you're you know nothing's visible on that skin. That I could see you know. Just in case. We don't have any sinuses right? Show me where it's hurting. It comes down here, I mean right around my knee. Sometimes here, but it comes right up here. Also okay. So it's actually like the menial lateral groin. And sometimes I mean this incision. sensitive. Is sensitive. I mean I would think that it would by now would be a little more stable. Me too. It's almost a year in January. Can I take a picture of the" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Over here. So we're following up after your chest skin and your leg skin and both things looked good. Okay. The radiologist thought so too, which for the chest skin is more important than what I think. How's your leg doing? It's doing fine actually. I'm doing a lot more. Good. Any concerns? No, not with my leg. You don't feel any lumps, bumps, you're not feeling bad again, appetite's good. Oh yeah, I keep eating. Good. How much are you doing activity wise? I'm walking a lot and we live in a house that has three flights of stairs. So I'm doing a lot of stairs. Doing a lot of stairs. Yeah. Okay. And any pain at that back of the leg? Nope. Does it feel weak? Not weak. It feels a little stiff, but the doctor, Constantine, says that's going to soften up. Other than that. That could take a couple of years. So don't expect that to happen overnight. Yeah, any numbness or tingling that you're having? No. Okay, man, it's all good. Yeah, I guess. It's awesome. I mean considering where you started. Yeah. That's, you're not allowed. Sorry. That's a permanent restriction. He's too fussy anyways. He's way too fussy. He wouldn't let me do it if I could. Yeah. No, I long ago learned that all you have to do is it the wrong way one time and you never have to do it again. That's what he comes with. Yeah, that's what I was told. You don't just do random patterns and mispatches doing that? Okay, can I take a feel? Sure. Okay. How's your summer been? Okay other than that. Rain? Other than the rain? Yeah. It's been on and off. It hasn't been terrible. Down by the lake. Which lake? Ontario. We live right on it. Yeah. It's been windy I thought this summer. Yeah. This summer. We've broken an umbrella. It's awfully windy. The jet ski in the boat hasn't been out as often as I would like. Oh really? Yeah. We'll be spending all this rain. Maybe the fall will be. And then it won't be super high. They may need to put warm September in. That's good. Cool. How's your knee motion? So you're able to straighten your knee all the way. How far does it bend? Can you go back all the way? Yeah, 130 degrees on your right side. That's good. I didn't feel anything. Your incision feels flat. It does feel a little thick or woody in the back of your thigh. But that's expected. that's normal. No bumps or lumps or anything that I could feel. Good. So Dr. Victor is meeting with a patient right now so you may wait a little bit for her to come in but I wanted to let you kind of in on the good secret and we'll plan to stick with our surveillance routine. It's been every three, yes, three months right now. First one was four and then the last one was three because I had a question. and Dr. Victor said, no, there were supposed to be three, something must have just happened and it got pushed up. Okay, and then sometimes if things are looking good with every three the first year, then we go to every four the second year, and then every six the third year, things are looking good. So, and what we can do is plan on getting those imaging tests ordered for a few months out, and then have you see us hopefully together in clinic. Right. After okay, okay. So anything that you need? No, okay cool. All right, we will let you know Review of the CT chest Without contrast Reveal stable small pulmonary nodules bilaterally And a thyroid nodule of the left globe MRI femur from 8-14-2023. There is fatty atrophy of the hamstring muscles that remain and notable missing hamstring musculature consistent with her prior. resection. The sciatic nerve is present. There are no areas of not... enhancement. No signs of locally recurrent disease." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hello. I can't hear you. My computer tells me that your phone microphone is off and your camera is off. They both are off. So Shelly, your microphone in the computer is off and your camera is off. I cannot hear you. I cannot see you. Both. Okay, okay, I'll try it again She was supposed to come to the computer. Did you talk to her? She has a camera and a microphone. So I'm going to go to the bathroom. Yeah, maybe one day when we're... It's a little bit tricky. Are you with your cellphone or the computer? Somebody that knows lots of computers, like a young person, one day can help you to tell you how to turn it on, but it's okay. Just with the phone this time. How are you feeling? Just like before or worse? So you're not more tired, stable, tired? Well, the blood work that you did at the end of December," [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Introduce you here and I'll look at this once a while to make sure it's still working We have Dawn here a new patient visit for left foot. So Dawn What I've heard is stirred bother you in about a month ago. Is that right? Yes, and no specific injury. You remember? Nope I was just coming back from a walk and when I stepped down I was it just hurt So when I when I stepped down I felt it back here But it doesn't hurt when I press down here It hurts right up in here. Okay. Gotcha. On the top part. On the top. Like kind of where your toes meet your foot. Yeah. They're kind of the base of that second toe. Yeah. I've heard that before. Okay. I got it. I think I know what it is. Let me just make sure it's nothing else. Okay. Um, any change in activity? You said you were walking or walking for exercise or what? Yeah. Just, just doing my daily, you know, nice walk, um, just to get exercise. And then, so when I got back the next couple of days, I decided not to go for a really long walk. because that's how bad it hurt. So I actually didn't walk. And then, you know, out doing things. So then I noticed like I was basically limping and at work people were like, what's wrong with you? Like, I don't know. Right, gotcha. And you typically walk every day you said? Okay, and work wise are you on your feet at work? Yes, I'm a teacher. Teacher, all right, what do you teach? Fourth grade. Oh nice. But I do intervention, so I pull small groups of kids all day, working on reading. Oh nice, that's good, good stuff. And then health-wise, do you have diabetes? Good. Do you have any history of inflammatory arthritis or rheumatoid arthritis? Nope. Any history of osteoporosis? Nope. Good, good. All right, good. Can I exam you now? Sure. Do me a favor, can you stand here? I want to see if that alignment has anything to do with it. There you go, so on. This is a little exam, I'll make sure things are working, still working there. neutral alignment, no significant deformities in the forefoot or midfoot. There's no significant malalignment of the great toe or lesser toes. Good, yeah, see for me, thank you. And then on seated examination, this is left one, correct? Yep. All right, you bring this up a little bit for me. There you go, perfect, thank you. Left lower leg, ankle, and foot, can I see this side too? There's some very mild swelling, dorsal aspect of the left foot. the base of the toes, middle aspect. Put this side down. There's some mild fullness. Is it kind of tender right in here? Yeah. I'm sorry, yeah. There's tenderness. Yeah, more so when you kind of get over it right in there. Yeah, there's tenderness at the second metatarsophalangeal joint. How about over here? No. None at the third. How about along here? That's okay. Yeah, yeah, so no, see. Right there. Yep. There is also some. tenderness along the dorsal second metatarsal shaft but it seems to be I think less than the other area. All right let me take a look here at your x-rays I was looking a little bit before I came in but I always like to review them with you and then kind of look at them after I examine you that's the advantage I have over the radiologist they don't get to examine you. So we have x-rays from visit weight-bearing three views. that are personally reviewed, interpreted, and they show. There's no advanced arthritis at the metatarsal phalangeal joints. There is no apparent stress fracture of the metatarsals. including the second metatarsal. Overall good alignment of the foot. All right, so the x-rays look pretty good, but you know, kind of a couple things going on. I think number one, it's most likely that you strained the joint in your foot, that I call the metatarsophalangeal joint, especially that second one, that's right where I was kind of pushing on. I've heard that before, when you take a step, you kind of aggravate it. You could have, the other thing you could have is maybe an incomplete stress fracture. of that second metatarsal bone. I don't see any signs of it on the x-ray at this point. If it's been a month, if there was a crack when it happened, we'd see kind of a healing response. So it's less likely that, but there could be a component like that bony injury or what we call a stress reaction or a precursor to a stress fracture. If you get walking on it and kind of were silly, maybe you could complete it or something, okay? So those are the things I think are going on. What kind of questions do you have for me? Well, I. I have noticed that since it happened to noun, it's not as excruciating painful. So it's getting better. But, and then the more, but the more I use it, so we're moving. Yeah. So this weekend we were moving a lot of stuff. So the more I'm on it, then it like the more painful it is. Okay. So let me, let me summarize what we talked about. So we, we discussed treatment options. Please include this in the dictation. Either a shoey or a shoey. with more of a rocker bottom and relative rest versus a walking boot. She's having a daily pain, walking differently. She decided upon a walking boot. I think it's a good idea. She was instructed on how to use the walking boot, a high walking boot. And she can do an exercise bike for exercise. We discussed anti-inflammatory measures. It's in the patient instructions. And she is moving. So this hopefully will help. her with her moving activities and then she'll follow up in about three to four weeks time. I would like to get updated x-rays at that point weight-bearing three views of the foot." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Yeah, so I guess fill me in in terms of like, what's what you've done for it over these last three years. I did physical therapy for about two minutes after my first doctor saw me. No, I the physical therapist. I work out. I've been working out for my whole life and doing sports competitively. So the physical therapist said that in terms of muscle function, I should just keep doing what I was doing already. And she gave me some exercises to do, but it didn't really change anything. Um... And since I also had problems with my knees, a doctor said that I had dislocated my patellis. Ah, OK. And he said that I had strayed my knees and said that he saw evidence of repeated dislocations. But that shouldn't affect what you're talking about. I mean, that's a good thing. its own separate problem, but I don't think that's probably affecting what you're experiencing now. Yeah, he referred me to an orthopedic doctor, but I wasn't able to see him. So I went to another doctor who referred me to a rheumatologist. So you had a rheumatology workup? I haven't yet. It's in two weeks. OK. But both of those doctors said that they thought that I had had. bromomal Ehlers-Stammer syndrome. Okay. Um, and... Can you touch your thumb to your forearm? Okay. Okay. With my other hand? Yeah, like, you know, I can't get my thumb here. Oh. But like... Yeah? Yeah. Okay. Um... Do you hyper-extend the elbows? Yeah. Okay. It's possible. And I was in Michigan over the summer and I had to go to urgent care there too. And the doctor there said the same thing. But that's it. I've just been passed around from different doctors, because no doctor has actually been able to tell me what's wrong. Yeah. Let me examine your hips and your back here and see if something comes out. I'm from an orthopedic perspective. We're focused primarily on the joint here. I don't think this is a joint problem at all just based on what you've been describing too because joint problems are consistent Right, you'd be like I have left hip pain and I have it all the time right where it seems like you're fine And then something happens and well, essentially I do have like constant low level pain, um where in my hips and knees uh and but this was just Worse this was worse Yeah, I would love to see you when this is actually, because you said you're much better now, right? Yeah, I was also hoping that it would be nice to see you when this is at its worst. But let me have you do a few things. If you don't mind, let me have you lay on your back up there for a second. This side is all on the left? Yeah. My right leg, my right hip still hurts a little, but the left leg hurts more. So just bend your knee for me, I'm just going to kind of move you. I just want to see how your hips move here. You have a ton of mobility in your hips, huh? Yeah. Come here. Check your strength here. Squeeze your knees together for me. Is that bottom? No. Push that against me. Do you need that at all? No, not really. No. Straighten out this leg here. Keep it up. I'm gonna start pushing against you. Want you to resist me. Any difficulty with that? It hurts a little. Okay. Straighten out here. Do the same thing. Also bother you. Yeah, so when you're talking about the pain, if you have a point with a single finger, when this hurts, where would you point? Um, I think here. You think it is here? Yeah. I mean that is right over your inside joint. Does it hurt to the touch when I push deeply? Yeah. And same here. Anything up in here? Not anymore, but a little lower, yes. Around here it hurts a little. I'm just looking. And you never got diagnosed with scoliosis or anything up your spine, right? I'm just feeling your spine. It feels pretty straight. Yeah, it feels fine. You know, the only thing that we could do, because I just, again, I'm not sure how much I can help here. Has anybody ordered an MRI or sacrum? I don't know. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. No. You can try that. OK. What is that looking for? So if there is a sacral problem, if you're either getting some kind of subluxation or you're getting spasm in that area, if there's some kind of structural problem, it will basically look for all of those things. It's the only orthopedic thing that I can potentially, this is not a hip. I can tell you that definitively. This is not a hip joint problem. Your hip joint looks pristine on x-ray. Your mobility is great. This is not like an actual hip joint issue. So something else is causing this, right? And the something elses are just muscle, right? You could be getting some weird sort of spasm of muscles in and around your pelvis that is pulling on your actual entire pelvis and rocking it to one side or the other, right? Or you have something that's weird that's going on with the sacrum. You know, I know that one doc, he said. something about you know sacral cell fixation that's really really rare really uncommon but we try to take a look and see if something jumps out um and there's no downside to it MRIs don't have any radiation or anything right so there's not like there's no negative effects of having an MRI. Sure. Because honestly besides that I don't know what to tell you like I think that some of the things that you have coming up are good like I think it's great that you have a rheumatology consult I think having them run a good blood panel is going to be useful. So even worst case scenario, if it all comes back normal, you can just check that off your list, right, as potential causes. The only other thing I would tell you with like sacral issues with like muscle spasm issues around the pelvis, physical therapy in general is by far the most effective thing that's out there. Sometimes it's just getting into the right physical therapist and if you haven't done that, like I know you had that one kind of period of time where you said you did it and it wasn't that helpful, but I don't know that I would cross off as. therapy as like an avenue here all together because of that one experience. I think there might be some value in just getting into a good physical therapist too. Yeah I wanted to do physical therapy again but just having gotten, kind of been able to get a referral. Oh I can do that for you. That's easy. So let's, does that sound reasonable? Let's, I'll give you a referral for physical therapy, okay, and So the way it works is I'll send you a list of physical therapists that we work with. Pick somebody off the list and you just give us a call and let us know where you want to go and then we'll send in the official referral. I'm happy to order an MRI if you want me to, if you want to do that or do you want to hold off and do physical therapy first? I'll do the MRI then, just in case. So we'll do an MRI of your sacrum. And then in that case then we'll just see you back as soon as the MRI is complete. The process probably for MRI probably still takes like a couple of weeks so it still might be a couple weeks before you actually come back and see us. Okay and we'll go from there. Great. Questions for me? When I couldn't walk, they gave me a wheelchair at Urgent Care. If it happens again, is it okay to use the wheelchair? Does that make it worse? I just don't know why. you can't walk. I mean I don't love you to be in a wheelchair ever because as soon as you're in a wheelchair you're not like using your muscles right and so like it leads to actually break down and it leads to like worsening. I mean if it's for a couple hours or a day that's one thing but like you know. When I would put weight on my left leg I would get a shooting pain up my spine and down my leg and I would like see splashes. you So that's why they do it. No wheelchair. Yeah. I mean, that sounds, it was, you have to use it. You have to use it, right? But I would just say, long term, it's not that a deal. Are you still using the crutches, or are you OK walking at this point? I don't use them all the time. I use them on and off. Last thing, can I just watch you walk out of here? I just want to kind of see what's going on. I can pick up with your gait. Yeah, I mean right now this like still hurts a little to walk on. Let's get that MRI. I think it's worth it. And then PT. So I'll see you back in a couple weeks. Okay. Thank you. Nice to meet you. Nice to meet you too. Please insert a bilateral hip exam with no findings. Period. New paragraph. X-ray of the left hip, notable for good joint spaces, good alignment, and no early osteoarthritic changes, period. Plan will be for physical therapy, evaluate and treat for sacral pain and instability. We order an MRI to RadNet. MRI of the sacrum without contrast rule out is for sacral ileitis, period. Adding to history. of present illness. The patient has been dealing with some left hip and low back issues for about three years. Episodes are very much intermittent on and off. She denies any injury that started this about three years ago. She has episodes every few months that last for three to five days where she has what she describes as unevenness in her hips that leads to pain and difficulty with walking and ambulation. It was severe enough over the last few weeks that she was actually wheelchair bound for a short period of time. She has seen multiple providers and no one has been able to figure out what is going on. She does have an upcoming appointment with her rheumatologist. She's also seen both urgent cares as well as another orthopedist, but without a definitive diagnosis." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " How are you? OK. So since the iron infusion, you think you're feeling better? Spanish is better. Oh, Spanish. Oh, pardon. Pardon. OK, momento. OK. Okay. So you had iron infusion in August and your hemoglobin looks normal. July was August. August. But there's still a little low, but better. Are you still having a heavy period? I can be a little bit more specific. I can be a little bit more specific. How do you say it? I can be a little bit more specific. So I have to be a little bit more specific. Low or low? Low. What are the most specific methods? Like the... in English. Huh? What happened? I'm all trying to think on it. What is she saying? I haven't had a job with that in a long time. Yes. Um, IUD? Oh, that's a problem. So she thinks that makes her period heavier. Oh, okay. So whoever put the IUD, have you gone back to them to tell them that you're having heavy periods? But I think it's normal. They think it's normal. Yeah, so right now your iron is better, but still slightly low So if you continue to bleed like that in three months, you'll be lower. So I'm putting an iron to be given again in three months Okay, so you say that you will be able to give another iron in three months because if you continue to do the same thing you will be able to give another iron in three months. Oh, okay. But I have to have it in my pocket. Yes, but in three months you will be able to give more. Yeah Okay Okay, so you'll come in April, get the iron fusion, and then we'll check in July. So in April, we'll go to the hospital and we'll check in July. Okay, in April we'll go to the hospital and in July we'll check in July. Oh, okay. Okay? Okay. Good. Thank you. Thank you." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "This is a 30 year old male presenting today for follow up of a right wrist and elbow injury that occurred on 4-3-2024. Patient notes that since his last appointment, he's had significant improvement in both the wrist and elbow. He notes he really only has some wrist discomfort when in a weighted extension position.Please copy forward prior right wrist and hand exam. Please copy forward prior right elbow exam. For assessment, this is a 30-year-old male presenting today for a follow-up. We're writing a right wrist and elbow injury that occurred after a fall on 4-3-20-24. Overall, he seems to be doing well. His olecranon bursitis is...Although mildly present is improving and his wrist sprain is improving as well. I'm okay with him advancing all activities as tolerated and he can follow up as needed. He was instructed to return at any point if symptoms worsen." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Who presents today for follow-up on her right shoulder period recently had a subacromial injection approved and comes in today for that injection period. She does have an MRI which shows a high-grade partial thickness bursal sided tear to the supraspinatus but she is interested in trying management at least in the short term. As such she comes in today for the injection. She has physical therapy set up to start next week. Period. New paragraph. Please copy forward prior right shoulder exam. Period. New paragraph. Assessment and plan. R.S. L. E. is a 52-year-old female with a high-grade bursal-sided tear to her supraspinatus. We are going to proceed with a subacromial injection today. She's about to start physical therapy. We are going to give her a trial of conservative management. not work. We have already discussed that there's a very large possibility that we're going to have to convert to surgical intervention for this shoulder period. I'll see her back in six weeks time period new paragraph. She's also been seeing me for her left wrist. She has what sounds like severe carpal tunnel, but we've not been able to get any of the documentation for this. She recently got all that together. She'll make a follow up on this going forward so we can decide if we need to proceed with any type of surgical intervention for that left wrist period. Thanks for watching!" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm going to go ahead and get you. How are you? How are you? Not bumping anybody's knee. Yeah, that's for That was weird. Taking a What is it? Okay, let's see. Weird weird because I'm not used to being out of a brain. Okay. Good. Little little bit more concerned about pain and weird. Oh yeah. Your kneecap is not where we want it to be. I was pretty sure that was true. When did you start feeling different at some point? Um... Well... I'd say it started when those... When we started moving or when... When those enormous... Spasms? Spasms. Goodness sakes. Didn't help. Yeah. And then... And this is recent. Yeah. When I flex my knee... Yeah. I can feel like a rope. It's very uncomfortable. Yeah, I see why. So the patella is off to the side. I don't know, I don't know if you want this. You have everything set up. You feel it. And now the first where you press over here. Yeah, kneecap. Not on this side. You know, the kneecap, it feels like it's there, but I'm not sure. I'm not sure if you'll like the kneecap, it feels. That means... Where is it supposed to be? No, that doesn't feel out of alignment there. That feels like where it should be, but I'm deceiving myself here. As it shows it, let's go over here. Let's see, let's dislocate as we bend it down. They can't shoot that x-ray this way. straight. I feel a kneecap right there. Okay, yeah, you can feel that. That looks right. Okay. As we bend, let me just look at you over as you flex the knee. That's what I was feeling then with the the rope-like feeling. Yeah. Well, can you straighten out the knee? Yeah. I felt that. Yeah, that's what I feel. What's happening is coming in and out. That's what's happening there. Very strange. Let's look at the side view. Like any time you flex, it's going over. So, if you look here, you're looking at it flat on. And what's happening here is it's dislocating over like that. Yeah. Okay. That's why we're seeing that circle. That's why it was uncomfortable when I was trying to do the exercise. Yeah. And that's what's happening. Now, this one, how about… Should they have you bend your knee when you're like this? They're just like that. They shot the sunrise view. Yeah, so there it's dislocated. It's out of place. And then here, we can see here, it's off to the side right here. Cause I see that ring that should be over here. This is with you standing. And that was with your knee straight. So it's not even with that, it's not an ideal position. Now you have to get another MRI to see what's happening with your quad but see something's intact It's not so we remember before the operation hold that there. You couldn't do that. Right, right. So let it bend So some part of the quadriceps is allowing you to straighten it now So that's intact a part of the vastus medialis must have must have gotten disrupted That's part of your quadriceps. Oh Hold on there. No head trauma here so I can feel it there it's tilted over like that yeah it's hard for me to feel that border. And it's so swollen. Well it's not enjoying the fact that it's not in place. Yes, but I mean okay that's why the bottom is all swollen. No, generally there's flute. So after knee replacement there's swelling for nine to twelve months. That's actually normal. But with this added trauma with the second operation where you restart the clock. I'd be interested if MRI is going ahead. No, I'm not saying that you shouldn't do that. I'm just saying that it's sensitive immediately. Yes. This is where we spent a lot of time sewing up again. I know. I just want to make a cut. Oh, I know. I'm so sorry. So I can't drive. Well, I mean, you can be... You have some insight into how you can move this. If you can drive with your knee like this, you could drive. The problem is you have to move rapidly. That's my concern. Well, you need to get the MRI just simply to know, to make some plans here. I'm not sure why that we really, so looking back, my colleague, Dr. Ho, and me as well are really so really good to get it together. feels so it doesn't feel like completely dislocated here it's sublux that we would settle for it being partly out this thing it dislocates completely or almost completely as you bend the knee well let's get you set where do you have your MRI done before remember here let's see what we can do I got you here let's see if there's any chance at least a good place we need a good quality MRI they need to be able to reduce the artifact. Did you do it the same day you saw me? By some miracle? Well, that's miraculous. Okay, hold on, let's get you up here. Well, that's fine. We'll work around your schedule, obviously. Okay, do what you need to do. Let me open this up. Oh, I'm sorry, this is really upsetting. Okay, no. You know that movement? Yeah. That's only been the last two weeks. It's felt like that? Yeah. We had all that spasm. I mean, you can get spasm just from being confined in the brace and extension. That happens in casts too. So I don't know if that did it. I don't know if the repair didn't hold. I'm not sure. But let's find out. Okay. So... MR... What was your quadriceps repair? March 31st. And the original knee replacement? January 31st, Jesus. March 31st and January 31st. Well, I believe something isn't what just happened. We had it sewn up in place. There's not a lot of paint. There's paint every now and then. It's like fireworks under my knee. I'm going to talk to the lady and see if we can get this, where we can get this set up. I know it's a lot for you to get up here. Late today would be great. Okay. Because I think they stopped serving it too. I don't know. I clearly don't belong. Well, it's better not to belong to me a guest. Yeah, exactly. Alright, let me talk and get them working on this. And can you tell me what medications I'm supposed to be taking? Um, supposed to be taking? Let's see. I have select... Celebrex? Yeah. Celecoxib. Yeah. I should be taking that for you. Well just to reduce inflammation. Maybe once a day. I take it once a day. Okay. All right. Celecoxib. I mean you could take it up to twice a day but it's more likely to stretch your kidneys if you take it more frequently. Okay. More on this daily. I don't want to do that. If you want, you can get a medication list and we can discuss it for you. you know that center right Okay, so we're gonna work on that. Okay. Yeah. I don't know if I seem to be roped in. I'm baffled. So I want to know what if there's evidence clinically, your quad is working because you can straighten out your knee. You can have an intact quad and have the kneecap still slip out of place. So that's a different issue. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. But yeah you tore the VMO, avastus medialis, that's what we repaired, that's part of your quad. And so it's possible that didn't heal or that tore again and that you partially healed that's why that it's not holding in place. So we need to find that out just for planning. Okay. I will show my colleagues this. Okay. All right." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " So I've been getting your blood counts results from where your place is. Fortunately everything has been looking decent there. I mean your platelets continue to run low but other than that everything looks okay. Hello. Yeah and what about the belly and all of those things? are looking good? Okay, okay so like the hemoglobin is good, the white count is good, the platelets are still in that 65,000 range. How many cycles have we done? We have done four. Okay I need to try and get a scan after this cycle okay I want to make sure things inside are looking good or you know you are looking fine too so that's reassuring because if things are all good then I need to start what's going on in these labs. Then I need to talk about cutting down on your treatments a little bit more. So when is the cycle going? I think it's, it's today, when is are we starting today right? Yeah today and tomorrow. Are we starting tomorrow? Well hopefully it depends on how you do because if you behave yes it's just you know just last time and again this is a slow process so I'm not, I'm not too we don't need to push you too much. So that's yeah, that would be the the ideal. And I'm just trying to figure out when did this platelet thing start with you. So when your platelets have been sort of looks like low. even from before. No I'm just saying even when the doctor, what's his name? Lemon. You know platelets have not been like normal for a very long time so they may never get there because I was like you know if it was really a cancer problem by now it should have normalized and it's possible that's what you know this is the best we can get because going back even in 2014 I'm looking you have been running low the whole of the whole of the last couple of years you've been so I feel you're close to your baseline okay the reason is if you feel the platelets low is a reflection of your disease then we will talk about continuing more treatment okay typically we will plan to do about six cycles before we put you on on some maintenance okay yeah yeah so this whole week counts as as one cycle so this is cycle number four yes and again you know all your symptoms have improved which is your night so that your fatigue all of those so that's why I am I'm thinking if it may be time to you know, get scans and start talking about scaling back a little bit. Okay, now we usually I don't like to stop completely, what we will do is leave put you on Rituxan or something of that sort. So you're still here once a month. Okay, as you realize this is almost like a chronic disease. That's why I don't like to leave people off completely. Okay. I mean, the rest of your numbers are looking good, sir. I don't see any else going on here. White count's good, platelets are good. So hopefully if you don't have a reaction or a problem we'll go through the remaining. Okay make sure you have your steroid and levaquin just in case. Okay because he ends up doing that funny thing sometimes when he gets the retuxin and then you always call me at six o'clock. you don't need to stop them. They can be functional join. So let's call in Lebakun. For I call in the Lebakun, you can call in this time, and I give you some practice. What that does is that I can speak up. And because I think a lot of time it's the what did we have actually before? We have the practice. Yeah. refills. Both of them we can refill and you can pick it up there today. This will continue. Yeah this is this is for the virus. I'm going to give you the prednisone and the and the what you may call the levaquin to keep at hand. Okay and if you end up using it just get refills from here. I mean he does get the steroid as a part of his treatment so that shouldn't be happening. But we'll see. So we won't know about tomorrow until after... You know, we'll plan for tomorrow. Okay, that would be... we'll plan to do treatment tomorrow. Obviously, if something happens, then I will skip that and then get you that shot. But the hope is we are able to go keep on track. Okay? You mean if you... Yes, then you can let me know or come in next week and tell me, hey listen, this is what's going on. Yeah, I mean, even his kidney function, everything is looking good. It's last time it was really, that's the best it's been in a while. I hope the leg swelling is improved too. Yeah. Yes, yes, yes, yes. Everything looks good. So I think his hemoglobin is good. We don't even need to do the red. cell booster today. So we'll move that out too. So I'll check back with him in a month then, okay? Assuming nothing changes here. Okay, by that time we should have had a scan hopefully by before the end of the year, just to confirm everything is looking good. We'll call you on those scans. Yeah. Yeah, plan, plan not to upset my rhythm or your rhythm. And then we'll go from that. You know, I'm not having him see us. the middle of the week if you are able to get those CBC's he did okay so are you guys okay if we just see him directly in in in a month right because previously we were having him come in every other week and he hasn't needed that shot at all so I'm really okay if you guys are okay is that okay sure David that order for we have to try and see if we can get it done this week this is not done at El Potah Our pet is done here, and I'll put on. I thought the pet we do. The pet we do at El Poton. okay that's fine okay ma'am this sounds good let's keep you going and then we'll check back with you in okay yeah I mean nothing changes I just stopped the Alokirunol I told you to stop I don't know where that is here but everything else is be the same no I don't see it here but everything else looks good okay Perfect. Okay, sir. Wish you happy holidays. I'll see you next year. Stay safe and stay out of trouble. No, no surprises, please. The next schedule is in January. They will get you this, yeah. Impression and planned recurrence, LLSLL with increasing abdominal masses. Dr. or Mr. McKeilbane is seen on coaching for further evaluation. He continues on Ben de Mustin and Duxson. He's now finished three cycles, that's cycle number four. He feels a lot better. B symptoms are resolved. So also his abdominal swelling, leg swelling and adenopathy. Platelet counts still remain low, but looks like that has been pre-existing. I think his baseline platelet is more like 65, 70,000 and he's at gold. At this time we will plan to finish out cycle number four, plan to do a scan. If he has a good response, maybe finish out with six cycles of Bendemosin, Toxin and then talk about putting him on maintenance therapy, possibly with a single agent, a Brutnib. or combination of ibrutinib and or rituxan. Patient in the family was agreeable. Next number, weakness patient was not have increasing weakness. Fortunately, he's doing a lot better from that standpoint. His blood counts are stable. Next number, multiple electro abnormalities patients, electro abnormalities have now resolved. Next number, bilateral axonema. This is also now resolved." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " It's an 11 year old male patient presenting for follow-up of a right big toe pain after a trip in a carpet at 11-14-23 period. The patient had pain directly over the growth plate at the last visit concerning for possible Sultor Harris 1 fracture vs toe sprain and is here today for re-evaluation period. Hello. Hi. Hello. Alright, how's the toe going? Much better. Much better? Do you feel like most of the pain is gone? Most of the pain is gone, but still my toe is right on top of the toe. Okay. Alright, I'm going to have you take off your shoes for me, okay? And then let's take a look one more time. He said it hurt walking on the way here. Only once because I put more pressure downward. Yeah. Okay. Alright, let's see. Last time, basically just to recap, we didn't see anything very abnormal, but he does have pain over the growth plate that was especially a possible growth plate fracture. So that's what we're here today to just re-examine to see whether or not we're still painful today. Okay. There was one other time too, is when you were leaning over the stairs and something happened. That made it worse for not so much. Oh, is it alright? You done? It's really only that. Oh, but you're not. And there? A little bit, yeah. But definitely right there, right? You're so tender over the growth plate. I think we'll just treat this as if it is a complete fracture. What are your main activities? Remember we danced, right? I do ballet and fencing. We would need a note. if we want him to not participate in ballet, dancing. He has no friends. He has no ballet and fencing. Have you tried doing dancing for the last two weeks? No, I have tried not to. OK. Yeah. I think we'll just hold off on it for another two weeks, OK? OK. And then we'll be able to get you to a really, really sad track too. Well, we started a trip on the 14th, so then that activity's out of the question. Is it possible for the note to cover through the 14th? Absolutely. OK. Thank you. Sounds like a plan. That would be helpful. Yeah. Definitely. I think that's painful compared to last time. Remind me, was there bruising that showed up? It was swollen but it got down immediately. Yeah, right now it looks good. I don't see a lot of swelling. But definitely, you know, continue to just minimize activity, like high impact things. Yeah, the 14th is actually exactly 2 weeks. No? That does a little bit. Okay, anyway. Any going out? No. No, not yet. Okay. Okay. So, when do you guys come back for your trip? Actually, mid-January. So, it's not any kind of sports trip. We were considering skiing. Would skiing be a problem when you have your foot down in the boot? No, those boots are going to be fine. Okay, because they protect the foot from the bend. Yeah, because they're so stiff. Okay, so it would be walking and potentially skiing. Would it be really that main idea? on the trip if those are both okay and we're good for the trip and then we can make a follow-up appointment if you want after mid-January. Yep, sounds like a plan. Should we practically do that? To have him checked again in January? Absolutely. Yeah, also after you know you do the skiing to see whether or not there's some persistent pain too. Yeah, and if he does have pain while skiing, I guess we just stop the skiing. Yeah, if it's like sharp severe pain that means probably over getting it. But it's a little sore. Fine. Yeah, as long as you're keeping it low impact because Skiing should be it doesn't seem like an impact. Yeah to me down. Yeah, unless you do a lot of jumps maybe Yeah I and then I could go on a bit which is fun. Oh, and it's fun. Okay? Yes. Alrighty, we'll see you guys back when you come back for your trip, okay? Okay. Happy holidays! You too! Please copy the prior Breath foot exam. That's been planned with 11 year old male patient presenting for follow up over right. They took pain after tripping on carpet on 11 slash 14 slash 23 period. Patient had pain at the last visit at the approximate base of the distal fan legs over their growth plate. Suspicious for a Salter Harris one fracture versus toe sprain period. We re-examined him today and he continues to have pain at the same location over the growth plate, to is likely a Salter Harris fracture period. We'll discuss about, of refraining from high impact activity for the next four weeks. And we will treat it with fracture and patient and family will follow up with us. after they come back from their trip a month from now period" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " presented for follow up on how he's been dealing with the male border. He was last seen in May of this year and did have phenol and alcohol matrix activity of the border. He knows that he has had issues with recurrent ingrowing of this male border that is painful. He has been managing it since an injury dating back several years, but continues to cause pain and discomfort. He notes after recent phenol and alcohol major eczema. He is starting to again have pain and discomfort. He feels the nail is growing in. In two cesh border cells, petism posterior to the left foot. Left hallux toenail demonstrates re-growth in the medial nail border with ingrowing proximally. There is no sign of infection such as redness, warmth, edema. There is no abscess. There is tenderness to palpation. Assessment of chronic ingrowing of the left hallux toenail plan. What is failed phenol and alcohol matrixectomy. procedure or removing more of the nail. However, since he has failed, a chemical matrix actomy may respond more to a surgical matrix actomy. We did review that this is a bigger recovery and requires incision and suturing and would need to keep the area dry for 10 to 14 days. He understands this and after discussion of options does elect. This procedure is what we scheduled at its convenience." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Follow up for high deficiency anemia and recurrent deep venous thrombosis. B polymer and gap in the left consider but also have thejing What are you doing? Right this moment. He's feeling out of balance, maybe a little dizzy. OK. You want to sit for a while? I'm sitting for a while. OK. Get up a little. Get up. Right there. Not stable. See that? He does sometimes practice his blood pressure, but when he gets up there. It was 1-3-7. That's fine. But... Yeah. It'll...it'll... It'll... Okay. ...the whole day long. Well... And... I'm trying to get 10 to the next 12 today instead of tying it back tomorrow. It doesn't make sense. So I'm guessing it's monthly. I'm in 1000 micrograms today. Do you know that his form is a black out woman and his doctor is off. And that's why he has a head CT because he wants his life's back and that's the purpose of doing the neurological workup to do that. And of course, it all looks pretty good to me when I read the results and took that last section. And I get it where I have the report so you'd be able to. Where was it done? Because I don't have it. When did you do have the report? Today. When was that? The 26th of January. I doodled. So this is MRI of the brain on January 26, 2024. So... Number 3. Yeah. The slide that... It's so prolific, that's why she's in it. the difference of the right frontal bone. But it is not to anything else. No brain metastasis and no, not anything else. And you know that's not. I want to say, where is my pain? Right? Yeah. That's why I was your dad. Well, I'm just... I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. Yeah. Because if your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, your, to come up until later. What was the last one? Last one, November 9, what? Next one, 0.05, undetected. parkshowers.Fr benefit Trioerizzyvel relief of It's undetectable on RSA. It's under control. It stops for the course of cancer, hormone blocker with a mutilate. You're not going to need to do another one until April 26th of this year. And no victims show you death since May. And we'll continue that. Please do not report me. But that finding does not affect your health. I'm not a quantum system, so having things would be. I'll wait for the iron level to see if we need any iron in the future again. And I think the lecture code, if I could try for the moves and the... No, he looked at the side effects and that seems like maybe... Okay, then he decided again, yes. Okay. We're sitting here. and I can see the skin. Is there anything better than a regular lotion that, you know, puts on sometimes the time? Because it's so broken down. It needs to be more consistent. Have to put in a lotion anytime to keep quite the day. Almost accurate. Yep. But at this point, you know, we'll get good results with the procedure appointment. I can't hold myself up. Unfortunately, that just sounds good. You know, the territory, when you're, you develop, you know, a lot of the things that you're doing, you know, you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going to have to be able to get to the point where you're going And so, if you will get the order when you're eating food, you're fine. Doesn't, you know, actually, the question is about, I tried to see the road. So. All right. So let's go ahead and get to your next question. I don't think we have time for one more question. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Well, I give myself. It's a high goal and it's tying up to maintain it. Okay. Okay. Okay. You're welcome. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hello. How are you? Good, how are you? Good, I went to the wrong office today. Did you go over to Brightman? Yes I did. Because I had seen you there before and I assumed, of course it's wrong to assume isn't it, I didn't realize you had three locations and I just went over there. That kind of skewed around a little bit. It was my mistake though. Not a problem. It's actually not too far away. Not too bad, I made it back at least. I appreciate that you're able to accommodate me today. Not a problem. I actually one time went to the wrong office in the morning. I'd been on vacation. Oh, dear. And I come here every other Wednesday. And so that threw me off. And so I guess we're only human then. Right. So I get here. And actually, Mo, who I think is the one in the room, dear, she was pretty cool. She's like, morning, Dr. Hi. I'm like, hi. She's like a. What are you doing here? She's like, you know, you don't have any patience on your schedule here today. I'm like, I know that. Okay, yeah. But actually I was at the Empire office and theoretically Empire is Webster. Yeah. Which would be theoretically further, but it's faster because it's just expressway straight right. We have to get up an empire right there. I'm pretty good actually. I made this appointment a long time ago. I'm not in any distress currently. The two issues are, one was this toe, the one that looks a little fungal or whatever. I have had quite a history with it over the past year. It started when I went to get a pedicure and I feel that I got an infection and I did see a doctor. I was down in Hilton heaven, South Carolina and he didn't do much but he put me on an antibiotic and it seemed to be a little better. And then a couple months later my doctor here when I returned Dr. Levstich, she also put me on a treatment for that one for an infection and it didn't seem to go away. But then it seemed to be more of a case of an ingrown toenail. Do you see that to be the case? It's curving in a bit, but apart of that it's also the thickness of the nail. So what happened was I went back to Dr. Levstich's office another time and her PA, I guess Henry I don't want to make her anything his name is. He did a good job, I thought. He kind of cut this whole section, just like a quarter of it. And that brought some relief. And since then, I haven't had too much of a problem with it, although it is still a little sensitive, right, at that point where it could be curving in, I guess, right here. But it's not like it was before. I couldn't even touch it. So I've been going through something with this toe for quite a while. I don't know what you... The other thing was, I had to feel this response a couple months ago. I started to feel a pain in the left side of my left foot whenever I'd get up in the morning and start to walk those first few steps. You know, I had me limping. And it was bad for like a couple weeks, you know, I was limping around. Then it seemed to go away. Then it came back a little bit, it went away. Now it doesn't seem to be there at all, but I can still feel it down there. not what I would call pain. A little bit on the outside here? Not the outside, no the inside. On the sole of the shoulder. On the bottom? Yeah, not in the middle but a little bit more this way. More on this side? Yeah, on the bottom. So that's where I would feel it when I would walk. And even when I got up out of my chair after watching TV I would feel that first couple of steps, some pain in there. But uh. Okay down in through here? Okay, a little pain when you hit that. What are you wearing most of these days? What kind of shoes are you wearing most of these days? Well I got these that you see over on the floor that seem to help because those are a stretchable fabric. I think maybe the shoes I was wearing before like sneakers or whatever were not doing me any good. And I know that I couldn't do my dress shoes because those were irritating that foot or that toe. Other than that... What are you up to these days? I'm a retired teacher so I don't have any work that I have to do. You know, I'm home with my wife, I play my guitar, I see my family. I'm not doing anything to spend your stuff. I have been getting back to walking. I've been going to the Y and walking the track and treadmill and such. What kind of shoes are you wearing for that? I have a pair of what I thought to be some pretty good... sneakers they're made by a company out of San Antonio SAS it's a good firm sole on it it doesn't bend much. You got some pretty good arthritis up in this joint. Is that what that is? Yeah. Or is it a heel spur or something like that? No, that's a big toe spur. That's arthritis up in through the air. Okay arthritis. Yep. Is that a swelling of the bone there or it's just? It's actually when the bones kind of get arthritic, they kind of bang into each other, you get spurs form up around the joint. Okay. So with this, a shoe that's got a bit of a stiffer sole is going to be good. However, I love the SAS shoes. They're great shoes. You know SAS? Yeah. Oh, okay. But. If you're going to be getting into like walking more, then probably would have you get a different shoe for the walking. Okay. And then use your SAS or like other kind of good shoe. All right, I've been using those as walking shoes, but maybe I better get some. They are, they're great shoes again. But for actually, if you're going to go walk, if you like for exercise walking, and actually watch, you're probably a sneaker. It's going to have great support, great cushioning, softer. around there, a modern sneaker, a good modern sneaker is going to be superior even to an SAS for walking. Okay. And then just general times the SAS would be a wonderful shoe. So will you recommend a particular shoe? So there's a particular place that I'm going to recommend and then I am going to recommend that you look at and they carry the Hoka shoes. What's it called? Hoka. Hoka. Hoka's are real popular. these days and people love them. I got a pair of Hoka's and they are one of the best shoes I've ever owned. But the other thing about the Hoka that not only is it good for supporting the bottom of your foot is they have a pretty stiff sole on them and that stiff sole like we're talking about is good for that arthritis because you can go out and walk miles and the sole is going to roll. instead of putting stress all up into here. So, I would recommend having one of the shoes you look at. Guys over at Medved, this is gonna be written down for you. They are wonderful, wonderful people there to help you get the best shoe for walking. Okay. Yeah. Where do you get your S.A.I shoes? S.A.I shoes, cause they're kinda hard to find these days. The order, I happened to buy them, I was living in Florida a couple years ago. And there was a shoe store and there was a shoe salesman, an older gentleman, who reminded me of my father. He used to own a men's clothing and shoes store. And he said, oh come here, you gotta try these. And he said, look how firm these are, you can't even bend them. He sold me on them and I don't think that was probably a good thing. Yeah, you used to know what to get around here. There's no place around here you really get to anymore. Yeah, I wouldn't think so. I haven't seen them anywhere. So you think the hand grown toe there that you have, you think that's going to be a problem? I don't think so. But I am going to send in an anti-fungal for you to put on that. You did get the nail wrong and out of your file case. So the fungus is an issue? The fungus causes the nail to curl more and be thicker, so it puts more pressure into the corners. There is a procedure that we can do for any wrong toenail, but if we've got a little fungus, we only try to clear that up first. If we're going to re-tape care of that, the nail's fine. And you don't need a procedure at all. Okay, so you don't need to resection that or anything or cut any toe, cut any toenail? We're not cutting your toe off today, no. Okay, good. What did you teach? What did I teach? High school English and then a little later on towards the end I taught Communication Arts at a performing arts academy there in Buffalo. I retired in 2002. And I've done some other education jobs since then But now I'm pretty much fully retired My fourth and last kid just chose Oswego. What is? My fourth and last child just chose Oswego as his child. Okay So I had hoped that one of my four kids would go to school in Buffalo because I like Buffalo I did my residency there and that's how I ended up in this part of the world. I see years ago but it's great town it would be a great town to have a kid in college you just go visit take out for dinner right yeah it's a good food town it is a good food town. Lots of good restaurants and big healthy food. Well we lived there for 33 years raised our family there. But our daughter lives in Honey O' falls now. My daughter teaches there. So we're here. We were living in Florida for a while, down in Charlotte, North Carolina for a while. So my retirement years have moved around quite a bit. My daughter teaches kindergarten down in HFL. In where? Hyneman Falls. Oh, does she? Mm-hmm. So it looks like you did a little fine tuning here on my feet. What about that pain that I'm describing to you that I get when I get up in the morning? That's why I want you to get the new shoes. What's it called? That's why I want you to get the new shoes. Oh, so that will have a corrective effect? I think that will help with that. Of course I get ads all the time on Facebook for a certain kind of sock. kind of support sling on your sock on your foot I don't know if any of that stuff is valid I would start off with the right shoes okay and is that what you call neuropathy that I'm possibly getting there your nerve test was actually pretty good my what your nerve test when I checked what did you do test me oh we do a check for nerves So you tested for that just now? No, we haven't done that yet. It's got a nice part here. Let me get this stuff in here. This is going to print for you and it will go to your mic chart also. Good. Okay. Light touch here. Can you feel this? Oh, you're... In here? You want to know if I can feel it? It's not a prick, it's just a light touch. It's not really pain. It's not a prick, it's not pain, it's just a light touch. Okay. You just barely feel it. Yeah, I feel it. that in here yeah tickles here that tickles a little yeah yeah yeah yeah I guess I could feel that very very light you should really feel it is yeah that's where it is yeah so the neuropathy you don't have a sense of feeling that with the rapidly you wouldn't feel that be tuned to numb correct Yeah, I think I saw you a couple of years ago. I was getting a pain here in my right foot at the bottom. When I was walking in the beach, I got a pain and it started to be painful. Then you gave me, you had somebody make me a little, what do you call that? A bed pad? A bandage of some sort. which seemed to help a lot. A little pad down there. So a script for an antifungal went to your pharmacy for that toenail. Okay and then the information we talked about with the shoes is going to print out at checkout for you. It'll go to your mic chart today. Alright so it sounds like the new shoes and the fungal treatment is the main" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hi Joe. Hi. Can you see and hear me okay? Yes. Okay good. So I wanted to touch base. I know you started treatment. How are things going so far? You're about four weeks in now. Yes. Do you feel any change within the tumor there in your neck? Do you feel like it's getting smaller? It's still hard to swallow. Still difficult to swallow. Yeah sometimes with the radiation you do get a lot of inflammation there. Do you have the feeding tube in? No. No. So you're still able to get enough calories? Yes. You sure? Yes. Okay. And then you got some hydration today up in San Marcos or? Yes. Okay, good, good. Well, I know we had labs on Monday. Your Whitesau count's looking good. Hemoglobin levels, your mildly anemic with the hemoglobin of 13. Platelet count looks great at 184. So the numbers look good. It looks like you're tolerating treatment remarkably well. well. I know this isn't an easy treatment to get through and a lot of patients towards the tail end do need to have the feeding tube put in. Right now you have two more weeks of treatment, right? Correct. So, I think your last chemo is going to be on Monday the 22nd and the last radiation is going to be on May the 3rd. So, actually we might add in one more cycle to give you on the 29th just to kind of coordinate and you know the whole point of the chemo is to chemotherapy is to make the radiation more effective. So we want to keep that in line. Of course, if you come in and your counts are too low, then we hold treatment. But I'll plan to do seven doses of the chemo, then your last treatment will be on Monday the 29th. Okay. Any nausea, vomiting? No. No? Okay. So yeah, you're doing really well. well. That's great. Yeah. When I first started talking to Dr. Hoops, he did tell me there's going to be seven sessions of chemo. Yeah. But I was told by you. Yeah. It kind of just depends on how we do the radiation, how many weeks of radiation. So basically, yeah, if you do seven weeks of radiation, you get seven doses of the chemo. Yeah. Sometimes towards the tail end, like I said, there can be a cumulative. So, you know, if your blood counts for whatever reason you can't tolerate it, we may have to hold treatment. But right now, you're just kind of breezing through. So that's great. I'm glad to hear that. Yeah. Well, and you're not needing nausea medications, you're eating and drinking well. So, yeah, if you need anything, let us know. Otherwise, we'll just plan to see you back next Monday, and I'll make sure that they have the nurse practitioner see you on the day of treatment just to make sure you're doing OK and that your blood counts look good. good. And it looks like we will keep doing the hydration on Fridays. Any other questions or concerns for me? Excuse my voice. No worries. After radiation this morning, I did talk to the doctor and asked him for a stronger pain med and he did prescribe Oxycodone. Yeah, that looks like that went through today. He also gave you a prescription for a viscous lidocaine. Yes. So you can swallow that. That will kind of numb up your throat, the back of your throat. And then yeah, the oxycodone, the five milligrams there. So yeah, just take that as needed. If you need something stronger or longer acting, we can always give you something like that. Even the doctor also told me that I can take three doses of Tylenol 500 at a time. Yeah. three times a day. Yeah, so I think the max on the Tylenol is 4,000 milligrams. So if you're doing 500, you can take, you know, up to eight in a 24-hour period if you need it. Hopefully not. So I even, I even needed to ask the doctor about the pain meds, but no, if you need the pain medicine, you need the pain medicine. There's nothing wrong with that. So like I said, this is going to get worse before it gets better. You know, you're, you're four weeks into it. You got three more weeks to to go so, you know. Yeah, we're getting there. Well, I'm glad to hear things are going well. If you need anything, just reach out, let us know. Otherwise, I'll keep letting the nurse practitioners see you every week while you get your treatment and I'll be available as needed, okay? Thank you very much. All right, good to see you, Joe. Be safe. You have a wonderful day. Thank you, have a great weekend. You too. Bye-bye." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I refuse. Nathan Gonzalez, a 38 year old gentleman here for his first post-op following an ORIF of a fifth metatarsal fracture. He had a Jones fracture period. He comes in today noting that overall pain is well controlled. He continues to have significant swelling in the foot as well as a little bit of superficial numbness in and around the foot itself. Otherwise, he is doing well. Period new paragraph, please copy forward prior to left foot exam. Range of motion is not assessed today. Incision is clean, dry and intact. Please delete the remainder. the exam except for the neurovascular section. New paragraph x-rays through use of the left foot were obtained today. They show good alignment of the fifth metatarsal fracture. There is still this area of comminution with a little bit of gapping along the lateral cortex. However, intraoperatively, this was found to be a result of a combination of the more proximal aspect, the overall alignment of the fracture. itself is perfect. Period. New paragraph. Assessment and plan. Nathan is a 38-year-old gentleman here. One week status post in ORIF for a fifth metatarsal fracture. He is doing well. I'm going to transition him into a short leg kambut today. He will remain strict non-weight-faring for a full four weeks. I'll see him back in three weeks with new x-rays. And we will likely transition him to... uh, toe touch weight bearing at that time." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Good morning. Good morning. Sorry. It's okay. I gave you a nice busy time, the two of you sitting here. How was the wedding? The wedding was great. Too hectic. Seven events in nine days. Oh my gosh. I had to take some time off to recuperate. Yeah, sure. Yeah, but all ended well. Yes, that was nice. Thanks for asking. So, let's take a look here. So anything new pain wise or anything? No, my back is the same. It's a big issue for pain. Okay. Let me see here. Okay, so are you seeing anybody that has done any local treatment, injections? From my dad. Dr. Amir, I think you saw, right? Yes, right. Is he working on anything or giving any more injections? We just finished an ablation procedure three weeks ago. I see. So don't know yet if it has helped. I can't tell the difference. Okay, so the MRI that I have is from January of 2023, which is more than a year ago. Do you think from January till now, if there's any worsening of the pain? Or is it the same? Or any better? It's probably about the same, I would say. Okay, all right. So... So August, when I saw you, we did the testing, basic testing for myeloma, and that came back all negative now. When I say negative, there's a second step test that we do if anything is positive in the first step and we didn't do the second step. Rarely, the levels of the Ig, the immunoglobulins, which are the abnormal proteins, instead of high could be low in myeloma. Rare, but it could be. So those levels are low still in your. the IgG, very low. No changes, same as what they were in August, today the same way. So, if you. And that's good. It's good, but to convincingly completely 100% rule out of those spots, then we may have to do bone marrow test. But before I do that, if you haven't had any repeat MRI. we can repeat the MRI because it's been more than a year. To see if there's any changes, if those spots are the same or have they grown or deepened or something like that or there's new spots, if that's the case, then I think we should check the bone marrow because sometimes blood tests may be not helpful. That's rare, but it's possible. But having said this, in one year, if you had myeloma, your... other counts would have been affected and they're absolutely not. They look perfect. White count, hemoglobin, platelets. Prostate test? Prostate test we did in December, three months ago and that was in the normal range. The kidney function, the liver function, none of that is affected. That I would think that if you had myeloma, that would have affected. So that's why I've been pushed for doing bone marrow test. But at least if you think. you could get into the MRI machine, I could order the MRI. Okay, of the lumbar spine to see. And this time, I would do it with and without contrast. And the reason is, I don't think the last one was with contrast, let me just check, double check here. Yeah, it was without contrast. So the reason is, let's say those spots are there and they're active, but they will take the contrast and they'll be enhanced. But if they're deadened, or of no consequence. they won't take the contrast. So that would be the difference. So they take images before and after the contrast. Okay, good. Yeah, we should do that. That's fine. Okay. If those show that those are dead and then I think we are okay. We don't have to do one marrow test. The only question would be should you get IVIG? What is IVIG? When...this is the IG level, immunoglobulin. that should be 700 or higher. Anytime it's less than 500, it can put a person at risk for infections and fatigue and so on and so forth. So we usually, okay. So it's an injection? It's an infusion. Infusion, okay. It's a slow drip over like four or five hours. Oh. And you do it once a month. When you give it, it goes up. If you don't give it, it goes down again. Because this is just lacking. It's not there. It's a rare type of myeloid. can have this situation too. That's why we'll see if we need to do bone marrow to exclude it rather than finding out. But even in myeloma, we have to do the infusion of the IVIG if it's low to improve the immune system. We'll see. We'll see. So that number has to do with my immune system? Correct. Yeah. So let's do the MRI, that's the first step. In the next couple of weeks hopefully you'll get that and I can call you with the results. and then we'll see if we need to do the next step testing or not. Because a bone marrow test is not a walk in the park, right? Correct. It's not. But it depends on who's doing it. I won't brag about myself. If you don't, we'd be worried. Well, the thing is, it's not painless. But it's not something that you cannot tolerate. But we'll see. I mean, if we need to do that. It can be done as a... you know by the radiologist under sedation, if you really don't want any pain. Otherwise when I do that, I do local lidocaine and then do that. So I do it like at least two times a week. But let's see what the MRI shows. Okay. Okay. So what is that called, IHG then? IGG. IGG. So IG is immune globulin. Globulin is protein, immune is immune. But those could be different form like A. So IgG is the one that's most common and kind of like line of defense against infections. So that's IgG that's low. And you can give IV Ig. So the difference in one year's time, there was not much difference? Nope, exactly the same. So well, since August, about seven months. So it was 353. It was. in August, 391 in December and today 354. So the same as what it was in August. So didn't drop more but didn't come back up. Okay. Are there any other symptoms that we should be of note for myeloma or just the pain? Well pain could be due to so many things but if it's affecting the kidneys it will cause extra fluid retention and. nausea, vomiting, if you're getting into kidney failure. But if there is a punched out, more effect in the bones, you will have more pain or fractures. So those kind of things that can happen. So in one year that would have happened, which hasn't happened, thank goodness. So we'll just do another MRI, and do a comparative with that? Correct. And with the contrast. All right, hang in there. Hi, thank you. Thank you. Thank you. Come on out here and they'll help you on the left side. Intro of history, John. Was seen by us to do questionable lesions in the vertebral bodies. And he's at chronic back pain and he's seeing Dr. Amir AMIREH. And has that ablation procedure three weeks ago which hasn't helped yet, period. We did testing for myeloma. Initial testing came back negative with having hypogamma globulinemia, period. And that is still the case, period. He continues to have the pain. The pain is not any worse but certainly no better period. His CBC and hepatic renal function is completely unremarkable period. John is generally doing well with the Swain Coma. He still has the pain period. I will repeat the MRI first which as it has been more than a year where I will this time do MRI with and without contrast. If there is any enhancement on those lesions certainly biopsy will be done either of those lesions or the bone marrow period. I will do the second step testing for myeloma in that case period. I will be discussing the results of the MRI if you... after the MRI via telemedicine with them and further plan will be recommended for your oral question and sarcoma reutuance with given in counseling within period. Copy to his doctor." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I saw you had filled some my chart yeah some toenail issues yeah um so like the pinky toes usually like I have the socks on and I called a few months ago and one was kind of like splitting on the side. And then I would say a year or two ago I had this toenail done because it was ingrown. Of course the woman I spoke to, I worked with her, she's like you went to the wrong doctor. She went to that doctor and then she gave me a reaction. She's like you got to go to him. So I was like okay. So I just didn't know if that looked okay. So yeah. So, tell me more about the fifth toenails. They split or they come off? They split and then they catch. You can kind of see here, I think, where you can see that one. I think there's more prominent. I've kept it that one's not as bad, but that one definitely like it'll usually in the wintertime it'll split when I'm wearing the socks and maybe dry, I guess. Yeah. Well, the skin, so the nail is an extension of the skin. The skin is drier and that's And then I wonder too if there's a component of the little toes are more prone to shoe pressure so we're more consistent in shoes in the winter which is creating a little more pressure. Is there pain when that happens? It is uncomfortable if it catches like the blanket and that type of thing. I mean it's not like my ingrown nail was where it was constantly painful but I wouldn't say it's super painful. more it will be occasionally but not like where I can't walk. It never been infected or anything like that. I guess I would have known that. Do you just cut it back? I do. I usually try to trim it as short as possible so it doesn't catch. Okay so a couple things we can consider and I'll put a few options out there depending on which way you want to go. We can talk more about it. And one, obviously, like you're doing is you could just if you're generally okay you could just keep it cut back as short as you can and kind of go that way. We could try, there are some nail I'll call them hydrating gels which may be a little bit of a mis-kneying. But to try to hydrate the nail, almost like lotion from the toe nail if you will to see if that reduces it. splitting in the winter to improve the quality and texture of the nail. We could do similar like you had here, if you said, I'm really kind of over it and if you wanted that side of the nail removed, we could certainly consider something more aggressive like that. And whatever, from my standpoint, if you were having repeat infections like a neck puncture or a cause for nausea, maybe you should just remove it. Yeah, but otherwise, you know, whatever you're I'm happy to do whatever you Yeah That would say I was kind of yours and like I didn't realize it because he said I'm gonna cut this and this but that Left side did bother me. I'm like now it looks like it looks somewhat normal. Do you normally take out both sides? So I personally I typically only take out if a science so only the pain Meaning from an aesthetic It doesn't I don't wanna say it doesn't matter but from the aesthetic standpoint. Um, it's more noticeable To me like the other yeah, I Didn't I ask about that I just thought that was the way it was done And occasionally I'll take out both of them and say, you know, that one side bothers me occasionally and I just rather never have my toe. That would be a really nice sign. Because what happens is if that was out to here, where it probably was before, it'd be really hard to tell. If someone would have to get down there and be like, I don't have to see that. Exactly. When I thought, I'm like, damn it. I don't know why I didn't think to ask that. Well, it doesn't seem like you should have had to. you expect the side is problematic to go on with the direction. Yeah and it kind of to me I was like oh maybe that's the thing that they do like maybe there's a reason for it. Yeah so anyways we'll point out right. It looks okay that now has a little bit of thick meat as do these guys so if we treat it depending on what you decide if we use that topical medication on these I would say use it on okay okay um do you think that So maybe I could start with that, but then if it bothers me, and then do you even know how far out you're booking? So what I was thinking of doing is if that's the way you're thinking of doing it, I'll send in the prescription, but then I'll just make you a follow-up appointment and say I'm going to do whatever three months or whatever it is. And then that way if you said, no, things are good, you just cancel it. Okay, perfect. And if you said, ah, I've got to do something. Yeah, I'm worried about going in. I have my two dogs in the room and I'll sit down and talk to them. Okay, so let's... or two and a half. It's really just a little bit shorter. Does it flip over January 1st? Okay, yeah, yeah. So I was like, man, I'm gonna start with this. So I'm gonna even have them schedule it as if we're gonna leave those news. If we don't, no problem, we don't. Whether it is that you say, okay, I'm just gonna cancel it, or whether you say, well, I still wanna talk about it, then that's fine. But we'll have it prepared as if we're going to do it. Yeah, and that makes sense to me if you know give it a little time and yeah Because I really didn't know there was like i'm honestly and I never know Tony else clipped out like that. So yeah And I thought I made an appointment with who she had recommended You actually fixed hers from this all from the first one I made the same mistake Right. There is no way you would know. I was like, yeah, I was just like, okay, this wasn't even a thing. But it's funny though, I mean, probably something you don't talk about with people in general, but word of mouth is a lot in any area. Yeah, definitely. It's always nice to know someone who's gone and has gone well. Yep. Okay. So, Will, I sent that medication before your- Okay, perfect. It will all- also soften the nail a little bit. The reason why I bring that up is you can start using it twice a day and then if the nail is becoming too soft, go down to once a day or every other day until you get it to the level that you want. Okay, great. Yeah, that's great. Thank you so much. I appreciate it. No, it's not. Well, enjoy the ... Hopefully when it doesn't come too soon for us. Yeah, I know. Oh my gosh. Thank you. both feet. There is mild adductor varus fifth hand, they're totally bilaterally. There's thickening of both fifth toenails with mild lateral nail border ingrowing slash splitting of the nail. There is no secondary infection. Right grade toenail demonstrates evidence of phenol and alcohol in the trisectomy of the medial lateral nail borders with mild thickening of the nail assessment. Chronic right fifth toenail dystrophy with ingrowing of the lateral nail borders are new treatment options and we'll start with. topical anti-inflammatory or topical keratolytic to improve quality and texture of the nail. Should this not be helpful, consider phenol and alcohol matricectomy which was reviewed." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a follow-up for Mr. John Raber. When I last saw him, approximately three weeks ago, I discussed with him that his stage IIIc squamous cell carcinoma of his left upper lobe and proposed radiation and chemotherapy followed by immunotherapy with Durvalumab. I noted the comorbid problems of vascular insufficiency in the right lower extremity and diabetes with complications including right great toe ulceration and osteomyelitis. Subsequent to my visit he saw Dr. David Hoopes to consider radiation and noted some concerns for biopsying the lymph node in the chest for consideration of possible surgical resection. He also saw Dr. Makani, pulmonologist, to consider endoscopic biopsy and biopsy period. Dr. Makani and I talked on the phone about the issues, noting that if the left supraglavicular lymph node was positive on biopsy that it would be a moot point whether to look into the mediastinal nodes or consider surgery. Hello, Mr. Raber. Welcome back. Hi, Dr. Langen. Hi. These are my two daughters. This is Haley and Alicia. This is Dr. Langen. And I saw you before, right? Yes. Okay. Well, since I last saw you, I've spoken with Dr. Hoops and Dr. Makani. Okay. And when I, I don't know the date I spoke to Dr. Makani, it was before Thanksgiving, I'm sure. And we talked about the whole issue was whether you should have surgery, right? That was the issue. And I don't know after the conversation with Dr. Makani, I'm not sure what he discussed with you, but I thought we together, he and I were talking that if we could get a biopsy of this left supraglavicular lymph node, it would clarify these issues. If that's possible, positive, which I felt it was positive from the PET scan, that would rule out surgery. That would make surgery not appropriate. Has that been arranged? Because Dr. Makani said he was going to do it. Okay, good. So six days. Let me just write that in here so I know I'm looking for it. So you said next Tuesday? So what is that? December 1st is Friday, 2nd, 3rd, 5th, December December 5th. the same time as his ebus? Well, that ebus was for the center of the chest. This is a CT guided biopsy, I'm sure. Certainly, but the port placement... No, he's going to do ebus is what I understand. Oh, he is? Okay. In terms of the port placement, if you're going to have surgery, probably a port is a moot point, right? So, we would really want to know if surgery is eliminated, then we'd put in the port. Okay, so we wait for that. Yeah, I think that that's reasonable to wait. It might be In hindsight, it might have been convenient to line everything up, but if you didn't need it and you're going to surgery, it's an extra procedure. In surgery, they can put in some long lines to sustain you during the surgical process. Overall, I did express to Dr. Makhani my concern that thoracic surgery to remove a large part of your lung is a big undertaking for anyone. And certainly with vascular problems, diabetes and other things, that's a long recovery. and a lot to go through. But nonetheless, if you have surgery and you're going through that, they can put in a long line that can last several weeks. And that would be sufficient. And then if we are going to say, okay, we want to do, let's say immunotherapy after that, then we can put in a port and do that. I just don't want to be pushing you into things that you look back on and say, I didn't really need to have it. So what they were talking about would be doing chemo first before the surgery. That's what McHenry said, three weeks of chemo. Well, then we should put in the port. Yeah, that's okay. Okay, we should put in the port. All right. Well, let's find out because surgery can take out, can dissect the nose and the center of the chest, but it cannot when we have disease at the supra-clavicular area, we're really out of the lung. And that's the nature of what we call 3C. Yeah. Which means it's just a step below stage four disease, which is farther more extensive. So if I didn't have surgery, Then when my lungs stay intact, I'd have more lung? If I had surgery, I'm gonna lose a lot you're saying? You're gonna lose some normal lung, but when you take out tumors, sometimes you improve the efficiency of breathing even if you have less lung. Okay. Because the tumor is taking up space in the lung that doesn't get air in it. And the blood and the circulation goes through it and doesn't pick up any oxygen, because there's no oxygen to be picked up. So when you take out the tumor, But it's more efficient. Sure. primary theme. Okay. So then as far as getting the port coordinated, how do we do that? Well, now was the port arranged already? I'm not sure. No, it has not been arranged. Okay. I don't... I'm not sure actually if the interventional radiologist would be willing to put in a port at the same time they do a biopsy. I'm not... I can't speak to that. Let me see... So it's a long shot. I requested now. Where do you live? By the way, I live in Oceanside. Okay. Well, then I and I asked for Doctor Moldovan, who's a vascular surgeon here in town who can do them very easily. I don't know what's best. It doesn't matter to me where the port is put in. Okay. So should we just contact Doctor Moldovan? I think we'll just go through Doctor Moldovan and set it up at a reasonable time. He's here in Escondido. He's in Escondido. He's very efficient. He does it in his office. He's a vascular surgeon. He's really adept at this. Like I, Dr. Choms here, he's vascular. Yeah. Did this. Okay, so we do it and... It could be done prior to the biopsy? It could be done at any time. It could be done at any time. He stopped his plavix now and he'll be off of that until just after the biopsy. Okay, I'll ask Ed if we can connect with Dr. Moldovan, make sure we find out and make sure you get a time for that. So let me come back again to the date so that I have a sense of when we could come back. We should get a biopsy report pretty quickly. Probably a couple of days to process the material, pathologists see it. Certainly four or five working days after the procedure, there should be some feedback on that. So let me Look again here at the dates. And so we still, so after the biopsies, can we see Dr. Hoops again to do the simulation? He wanted to wait two days. Well, again, if you're going to have surgery. Yeah, if it's negative, then we don't know that well. So you already have something tentative with Dr. Hoops? That appointment has not been finalized yet, but it's going to... Okay, well, I tell you what, I'd rather you cancel on appointment with me than not have it and we're going to have the biopsy on the 5th of December so I would think that by the end of the next week we have the data results so let let me suggest I see you on the 19th that's a Tuesday the 19th of December you think so after the biopsy. Lepsys on the 5th. Well then let's go December 15th, the end of the next week. Okay? Okay. December 15th. I want to know what it shows. We want to know what's happening. Whatever situation we're in, we'll move forward. Alright? Okay. So surgeries, that's what we're hoping for. That's a little bit better than having radiation chemo. There is no question that if you're operable, that is if it's possible to resect this and we can get rid of the cancer, that would be a very nice thing to do. However, I think it's pretty extensive. And I also think that surgery can be very morbid. What I mean is a lot of side effects and a long time of recovery from all of that. So let's be sure it's resectable. And that's why the biopsies are so important. Yeah, I don't know what that means. What is resectable? Well, it means that it's not so extensive in these lymph node areas that would be a surgery, but it would not get you out or get rid of all of the cancer. The doctors can cut out your tumor right now, but is that the best situation for you? Right. We want to do it in a way that, and I'm sure the surgeons would feel the same way that they would do it with the intent to get rid of all of the cancer. That would be their intent. If they didn't have that in mind, then that's not a good bargain. Is there any way of having the appointment with you that can be on the 12th? Well, we can do it if we don't have all of the data, but that's not a problem. Let's see, the 12th is Tuesday. So you're having, well, we can try it and we'll see what we get. That's a week after the biopsy. So the plan will be a follow up on December 12th is one week after the planned CT biopsy of the left supraclavicular lymph node and EBIS with mediastinal lymph node biopsies. The plan will be to place the port-a-cath as soon as convenient and compatible with Dr. Moldovan and Mr. Raber. And I guess the other thing now is, so assuming, I guess either way, if they're planning chemo as an adjuvant or chemo... Well, if the chemo is upfront, if they say we want to resect, that we call that neoadjuvant. So we do it ahead of time to shrink tumors much possible. If it's done after surgery and they feel we ought to do something more, we can do chemo and go on with the immunotherapy that we called adjuvant therapy afterwards. So it's done before surgery, it's neoadjuvant. Let's find out what we have, no problem to do all of that. So we want to see you. I guess the only reason I'm asking as far as, let's say what you kind of know, how long does it take to get them into a chair to sit? I'm going to start the chemo. That can be done pretty quick. It should be pretty quick. Let me finish this and I'll check on that too. December 12th. Okay. We'll plan to draw blood on your arrival here. Okay. On the 12th. Yes. And... Dr. Lemmon, do you recommend surgery? Or do you think the morbidity is too negative? I'm going to be honest. I'm concerned about that. Now, by the way, I've ordered the chemo. It's available. I can tell you it's available but not planned because it's listed in our flow sheet to be on a Sunday. That's our trigger for it's not set up yet. So yes, if we have to go to chemo, we order it and get it done as soon as possible. Yeah, my concern is the morbidity of going through. You have to, you have open, your chest is open, you have a chest tube, it's a recovery to take. I do understand the rationale to want that, but I do worry about your circulation. that there's more morbidity. However, I'm sure a surgeon would not want to operate unless they felt certainly they could cut it all out. Get it all out, 100%. Because by the time you recovered from all the surgery, if it's not all out, we may be saying and now here we are again. Yeah. With less mass but we still have it. How long is the recovery time if I have surgery? Six months I'll have it. The surgery will have to, the surgeon will have to discuss with you but the big part of recovery that is upfront. You have your, you'll have a chest tube you'll have to have the lung expanded and be on a ventilator until you're breathing better. Which is how long? Maybe a couple of days. A couple of days. And the next is to then get you back breathing normally and then the wound has to heal before we would want to consider anything else. So assuming that the wound is healed if there's nothing else left there and it's a good operation we just be watching you. Okay. So let's go. I mean I'm happy to have you have the best outcome possible. Yeah. I guess what Chris is thinking of. Yeah. But if that. Okay. Sounds good. So the chemotherapy has been ordered and it's sort of sitting here waiting for a specific request to get it going. So we don't have to worry about authorizations or setup or anything else. And with that, is that administered here or can it be at 4S? It wouldn't be at 4S. It could be done in Encinitas, in our Encinitas office, if it's more convenient. No, this is probably going to be more convenient. That's where Dr. Makani is. We're right in that area right there. Yeah, he'll probably be staying with us and we're down in Scripps-Powell. I see. Well, we would be doing it here. We've consolidated everything here for a while because of the nursing shortage. And we only had one nurse available there. And we can't have our chemo nurses by themselves when they're giving chemo for patients. So that's why we consolidated all of this here. OK? And is there... The chemotherapy, well, the chemotherapy would be, it's, you know, I would do it weekly during the course of radiation. And that would be two drugs. That's carboplatin and Taxol given together. So that's together. So again, if we, well, actually I have to, to, to rewind and say, if we're going to give chemotherapy as neoadjuvant, I would change the doses and plan same drugs, but we've be giving it differently. Okay. These are smaller doses every week to enhance radiation as opposed to just chemotherapy. And in fact, we could even do this with radiation, shrink the tumor and do surgery right away. That's another way of approaching that, where we do the surgery soon after finishing the chemo radiation. That would shrink the tumor with certainty. The question is, not the question, but you want to do the surgery within six to eight weeks of radiation because the tissues then get a little more tough and difficult to cut through. So all of that is true. But chemo radiation could be quite dramatically shrinking the tumor. And then the question would be, should we be doing chemo if it shrinks it so much? There's all sorts of variations on this. But at any rate, what's ordered to set up is chemo radiation. And I would change it in terms of this plan, but it shouldn't be difficult to change that. So we'll see you the week after your biopsy. Hopefully we have some results from that. Perhaps Dr. Makani will get it before I and can kill it. So this is what you would do. If this is you and you're in my shoes, this is what you would do. I would want to do the best we can. And there is no question that it has to do with the extent of disease. I think you have stage 3C disease. If you had stage 3B disease, potentially resectable, I feel a little different. But my view, based upon the PET scan, was it's up here. The biopsy is being done to sort of be the arbiter of that process. To see if that 5% chance or however low it is. Well, that PET scan was positive there. So if the PET scan is a false positive, meaning that you do a biopsy, there's no tumor, then okay, we don't have tumor there. But that's my working diagnosis, which means I wasn't considering surgery on the basis of the PET scan. Okay. So you thought from that, that the lymph nodes did have it. Yes. That was my view. That's why I called it stage 3c. And we're talking to Dr. Makani and all this debate. He was asked about this EBUS and the biopsy. I said, well, that still doesn't answer the supraclavicular. If we had a biopsy there, it's positive, it's positive. If it's negative, we say, okay, it's a false positive PET scan and acknowledge that it's just in the chest. So I'm sure he wants to do the EBUS procedure to find out about the central lymph nodes. Okay, so that's where we stand. We'll get it going as soon as possible. Okay, okay, good deal. Any other questions? So will your office be coordinating with the port placeholder? I'm gonna ask Ed if we can call Dr. Moldovan's office now and find out when it can be put in. Okay. Okay. So... He has another appointment with his foot doctor today. So should we call back? Alright, we can do that. Let me check with Ed and tell you what to do. Thank you, Dr. Lane. All right. Say nice meeting you, Dr. Lane. Nice meeting you. Nice meeting both of you. For Mr. Raber, call Dr. Moldovan's office and see when we can get a port placed for him. He has to get to an office visit in 15 minutes, so they can call back tomorrow and find out. So get him going for the follow-up for me on December 15th or something like that. Okay, Dr. Lane. I forget what date I put in there with the My impression for Mr. Raber, number one is squamous cell carcinoma of the lung, stage 3C on the basis of a positive PET scan in the mediastinal and left supraglavicular area. Two period. There has been investigation with regard to the potential resectability of this tumor, and that will hinge on the status of the identified mediastinal and supraglavicular of lymph nodes that were positive on PET scan. Dr. Makani has arranged for a CT biopsy of the left supraclavicular lymph node on December 5th. I understand that on the same date, Dr. Makani will be doing EVUS with biopsy of mediastinal lymphadenopathy. The question at hand is whether he is a candidate for thoracic surgery and resection of the tumor. I will be seeing him one week after the biopsy to review the biopsy data and perhaps to discuss with Dr. Makani and Dr. Hoopes the issue of coordination regarding the issue of surgery or back to chemo radiation or perhaps neoadjuvant chemotherapy of surgery as a consideration. Mr. Raber and his brother are comfortable with this plan. Period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Present state prophylactic right diabetic foot ulceration has been trying to be more consistent with removable cast walker. He does know he couldn't wear it several days because of the rain. He does have a history of diabetes with neuropathy denies constitutional symptoms exam, palpable Drosales pieces of posterior geniopause to the right foot. There is right plantar foot ulceration with significant macerated tissue to the plantar foot, not only surrounding the ulceration, but extending proximally. The ulceration is full thickness again with mild exposure subcutaneous tissue after debridement. There is ulceration measuring 1.5 by 1.1 centimeters with 0.3 centimeters of depth. There is no redness or warmth. There's no program or tracking or bone exposure. There is no abscess. Assessment diabetic foot ulceration rate plan also is debrided to remove non-viable tissue and encourage acute inflammatory response to healing. Masqueraded tissue is also debrided as well. Switch. We'll switch dressing. to a silver alginate dressing, which was applied today and you were dispensed to help control maceration. Continue with offloading with removable cast walker. I have recommended total contact cast in the past. He is unable to be able to comply with this on a daily basis. We'll reevaluate three weeks." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "Patient is here today for cycle 4 EMA Patient is here today for etoposide Acetaminomycin cisplatinE-M-A-E-P. CBC today. WBC 6. Hemoglobin 10.7. Hematocrit 31.7. Platelet 74. How have you been?No, this is the same. Do you have a pen? Oh, yes. I can borrow it. So your platelets are a little low. Do you notice your bruising? Any bruising? I do. I have my toes, this one. It's bruised andgoes numb only on that it's been a couple days already and then after my skin is kind of okay soI think.Okay, it's double L. Okay, so I'll give you a copy of the lab. Did she give you a copy? No. I'll give you a copy. So, counts look okay. So, white blood cell, I'll give you back your pen. The white blood cell is at six. Okay, it's okay.Yeah, hemoglobin is at 10.7 and platelets is low today, 74. Okay. So at 74, platelet is what helps your body clot. You know, like if you get a cut, that's what helps the blood to clot. So at 74, you shouldn't bebleeding and you're not on blood thinner and you're not taking aspirin do you take ibuprofen or no okay so then you're fine so because it's 74 and we want to continue treating i reduced the doses for today so she's going to get less dose than before but this this um it's a supplementokay you can find it at sprout okay it can help it can help the platelets to come up okay okay she can try it maybe try if they have the organist or is a pairIt's a supplement, so sometimes it comes in pill form or capsule, or sometimes it's a liquid. Okay. Yeah. You can check that there first. I'm going to give it. I'm going to have to. I'll take my way home. Oh, yeah. Okay. So energy is still low, or is it better? It's the same. If I can...drink something like vitamin water something that it's how we get the energy little better but I try not to drink it because if I drink those one it can be raised up my blood sugar so I don't drink it since the last time I spoke with you and I did not drink it did you drink a lot of water yeah but you can drink some how look at the sugaron the bottle for the energy drink read how much sugar is in it zero it says zero yes then you can drink that one zero but i you can you can you can drink that one i drink but after like a hour or a couple hour i test the sugar it did go up by how much um i want to say over 100 like noOnly it's 156, 176, right? It go up to 300, something like that. So I do realize like those water. Check four hours later. Okay. So next time drink it and four hour, you check the blood sugar and see. If it's 300, then not good because it should have come down. Yeah.yeah do that and any fever chills I don't have a chill well I just feel like I brought the post right here it's trying but every week I could okay around the post right does it hurt all the time or sometimes IIt's not all the time, only sometimes. Okay, sorry. Depending on how I move my body, sometimes it hurts here and I feel it hurts through the back. Do you like the pillow behind your back? Okay. Any nausea, vomiting? I have extras. Would you like this one? Any trouble with the real constipation? I still have the constipation. If I don't take the medication, I still have that one.take the medication I took a chorus okay for us give it to me my last time so that one it helps nice transfer okay what can I do for you today I don't see like much so I don't know okay nothing so I want you to look back on this scheme is a numberOkay, can I see? Can I see? Okay, sure. Oh, this discoloration on the toes? Yeah, yeah, yeah. That toe is numb. Just this toe? Yes, that one is just only that.Okay. It's been like more than three, four days already. I feel like this toenail is really numb. Okay. And anywhere else? Yeah, the discoloration here. Anywhere else where you have numbness? Just only the toes right here. Okay. So that's because the treatmentcan cause numbness tingling what should we do to help this as a real close a lasso you say he said that if anything can help we do this the effect of numbness you can takeYou can take, but are you taking any vitamins? Vitamin B12? Vitamin B12. And the other one is called Alpha. Alpha.alpha the point the pointto do help with numbness tingling let me know if it spreads to any more fingers or toes yeahIs the aching there all the time or it comes and goes? All the time. And you can zip things? Yes. Okay. All right. Yeah, so try those two. Okay.of short breathing or like a have a pain or chest is that is the aside effect? She didn't have it but I just have a question. Oh she doesn't have, oh well people can have chest pain and it you know it's not asside effect of the treatment, but if she was to have any chest pain, shortness of breath where she's having trouble breathing, then I would say going to the emergency room. Okay. Yeah. Okay. A case like this, she can wear a mini sock, it's okay. Yeah. Mini sock and a double clothes.Yeah, whatever she needs to do to keep herself warm. That's fine. The reason I ask because if she wants clothes, things like that can affect something. You know, this high effect, things like that. But if you know that you can give her the warm clothes. Yeah, she can. You know those socks they sell at Costco during Christmas time, the big ones?She can wear those." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "This is a 68 year old male presenting today for initial consultation of left elbow pain. He has a referral from Dr. Montgomery. All right. So again, I'm Lindsay, one of the PAs. Tell me a little bit about what's going on with this elbow. I'd say three or four months ago, I can't really remember. I was lifting a lot of heavy stuff and I felt my elbow go and it isit's not healing. I've had a fair amount of injuries and tendonitis over the years. So I'm familiar with how tendonitis feels. And just last night, for example, there were times like if I kind of do that or certain movements of the elbow, it becomes very painful and difficult. And, you know, with, again,and a lot of sports and martial arts and stuff. I'm going to be 69 in two months and my body is giving out on me. But I continue to work at it and now because my body is in such typical shape, I only do deep water classes. So I'm still doing them. So there's a lot of movement. I wear a sleeve when I do it. But it really is just not healing and my, generally they, one would say they'rerest it, but the thing when you rest at 68 or 69, it becomes debilitating. And so I've been trying to stay with it. I had a pretty really bad shoulder injury where I was wary, but Dr. Montgomery, who was my orthopedist, referred me here because he's only seen patients one day a week, and I couldn't get an appointment for months.he, in the end, after my second shoulder injury, because of the really bad first shoulder injury, they both took three years to heal. And he gave me a cortisone shot that really, really helped me. And I was very wary of taking it. Um, so what I was hoping was that he could, or you could give me a cortisone shot to just calm it down. And again, I'm not, you know, thrilled about getting it, but, um, that,So that's kind of it. That's that. Okay. When you were like, was it actually while you were holding something, you felt something happen? Or was it more kind of after the fact? It might have been after the fact. But, you know, again, with, you know, my two knee surgeries and I'm not going to say hundreds of injuries. But, again, you know, many years of playing soccer, basketball, softball, 12 years of martial arts.I've had my share of injuries and I kind of know when something's going on. I don't claim to be a doctor or a practitioner, but I worked at Rainbow Grocery for 34 years. I worked in the supplement section. Pretty familiar with bodies and nutrition and healing. So I knew that. So I was lifting these 40-pound bags of cat litter, these 17-year-old cats that have become difficultespecially the male and I clean the litter box constantly because otherwise he starts to pee. So again, I was lifting these four bags and, you know, I'm very wary of not injuring myself. So I keep my elbows tight to my body again to protect my shoulders. And I just, I knew I had done something. And then for the next couple of days, it was not feeling well. And again,say that was three or four months ago and you know can't stop living so left it like fix my house and things like that yeah so all of that and again I don't want to diagnose anything but I'm virtually positive it is pretty severe tendonitis and it's right in through here and it is really sore okay yeah there are certain movements that I know just trigger it let me have you sit up here let's startAre you right-handed or left-handed? I am right-handed. Okay. You know, the thing about injuries is, of course, you always protect one side or the other. And so I do more with my left sometimes than my right. Again, my right shoulder had so many problems, including it turned out, you know, it was during the pandemic or right before the pandemic. And I was doing rehab for the shoulder.tendonitis in the long tendon of the arm, it turned out. But then seven months later, I saw Dr. Montgomery and the pain was unbearable. Like I would reach and it was literally buckled my knees. And he came to me and he said, I see why you're in pain. You have a broken shoulder. And I was like, ah, thank you for saying that because I thought it was going insane. And then I had an MRI and it turned out I had a torn rotator cuff. Yeah.I had tendinosis, severe arthritis in my right shoulder, et cetera. So that I've become very familiar with tendinitis because of that. Anyway. Well, let's take a look at range of motion first. So let me see you straighten out both elbows. Good. And then flex up for me. Good. Elbows here at your side. And I want you to just rotate the hands. Any pain with that? No. Okay. I'll take your arm.So, straight on the inside. Any pain along here? Oh, sorry. No. Nothing there. Because it's really mostly on the outside. About a long triceps right here. No, I'm feeling it there, but that is not exactly where it is. It's right in here. Yes. Even maybe a bit lower down. You know, I try and work my fingers in there a lot.loosen things up a bit. Okay, you want me to press you in here? No, but if you went down a little bit lower right in here and right in there is where really the deep pain is. In here? Yes. Push up against me with your hand. So I want you to bring the hand up. Pain with that? No, but I feel it. Okay, kind of right in this area? Mm-hmm.I'm gonna flip you over. Bring the hand that way now against you. Other way. You know that? No. Does it feel like your elbow is swollen at times? It doesn't feel like it's swollen actually. So I'm gonna try to find that kind of point.Is it worse here? No, but I can find it for you. Okay, yeah. So right there is one of the bad spots. Okay. And the other one is on the other side. Here or here? Sorry. Right in there.there and going that way. And then right here. Yep. With me, like really pushing you into flexion here. Yes. And again, it's that spot right through there.Do you feel it fully straightening out here too? Or is it really just the flexion? No, it's, yeah, just the flexion. But I, you know, getting old, I wake up in the middle of the night for an hour or two and sometimes read and I turned over and sometimes when I put my elbow down and try and turn over, that, again, last night was a particularly bad one. Can I break here? Yes. Okay. So you have to do this.Right here is your lateral epicondyle where people get tennis elbow, where you get that tendonitis. But right here is your actual elbow joint. It looks like you maybe have a tiny bit of arthritis. It doesn't look too bad, but if your pain is right there in the joint, that makes me think it's more the joint, not that tendonitis right there. Because usually this is just severely, severely tender. And that kind of pushing up, usually people can't even do that. Now, we felt it a little bit,I'm sure there is some element of just inflammation here, but it's more kind of along the joint right in here. I think that's probably just that little bit of arthritis right there. Yeah. I would say probably let's do an elbow joint injection and put cortisone actually in the joint and see if that helps. To kind of target the epicondyle, we do an injection more here, but the joint's more in there. Okay. So I say let's try that. Now, if it doesn't work, then that would be our sign that maybe this is coming.from that tendon but that's what i was really pressing around that wasn't bothering you so willing to do what you think is right as i said i'm not a doctor nor uh can i look in there and see exactly what's going on looking at your x-ray here there is sorry yeahLike, every old is where he was. He never wore glasses until, like, seriously, four or five months ago. So this is the outside of your elbow. It's flipped on here. You have a tiny little bone spur there. That's kind of right in this area. And you also, it looks like you have a little loose body in here. It's very, very faint, but I wonder if that's maybe some cartilage at some point that...I don't see that loose body in any other view. And you still have good joint space throughout the elbow. You've got a little kind of spur in the back here as well. But that's thinking that it's probably just this kind of arthritis. I maybe got flared up with lifting. So I say let's do that. Elbow injections have to be done by ultrasound because it's such a tiny space. But I believe we have one here. I'll go double check. And so we'll get that going and we'll see if that helps. Do you take any daily medications for anything? No. Okay.I would probably advise, you know, ibuprofen or some sort of NSAID just for a couple of weeks. I usually just do like two week bursts. I don't like that stuff long-term. I agree with you. And I have only taken it when I've had a particularly bad time of, again, you know, I painted my house or a particularly bad time after a workout again with all that pushing and pulling in the water. Yeah. So yeah, I try and stay away from it,three years of taking iBlues nonstop from my shoulder. I would say let's do it just for a week or two, along with the shot. Let's see if it kind of calms it down. Do you want me to give you a PT referral? You know, I suppose, yes. Okay, let's do that. You know, when I had my bad shoulder, I did physical therapy and actually injured my shoulder more in the end. And that was, again, right before the pandemic hit. And I stopped.seeing this person only because I couldn't do it anymore, but it triggered this thing of I believe badly injuring my badly injured shoulder. So I'm a little wary of physical therapy, although I know that they can be very helpful and good. I'll send you a whole list of PT places that we really like. That way you can kind of look into those. Any allergies to medication? No. Okay. Let me goWe'll make sure our ultrasound is here and then we'll bring in everything to do that. I'm going to be really behind now too. Can you set the ultrasound up for me in here? I'm going to do an elbow injection. I've never done it.mild joint space narrowing and spurring. There's also a very small loose body seen on the oblique view, likely representing possible cartilaginous loose body. There's no acute fracture, dislocation, spurring noted at the olecranon and radial head. For assessment, this is a 68-year-old male presenting today for left elbow pain that beganthree to four months ago after lifting cat litter. I reviewed his x-rays, which show evident signs of osteoarthritis of the elbow, although it appears more mild in nature. He's continued to have symptoms, so we did discuss risks and benefits, and he elected to proceed with a intraarticular cortisone injection of the left elbow that was done under ultrasound guidance. He was given a referral for physical therapy, and he's going to start an over-the-counter anti-inflammatory for the next couple of weeks. He will follow up in six weeks. No, I'm jigneted. Thanks." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] Please send a referral to Pacific Rheumatology for large atraumatic left elbow effusion with negative MRI and remote history of other atraumatic joint effusions over the last couple of years. Sending for rheumatological workup. [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "And how is your appetite? Any concern? I hear you've been coughing up some... Tell me about that.Like, and it moves that way? I should have a trash can here. Did you swallow it? Or you need a trash can? I don't know. Are you rolling your eyes? Mm-hmm.Also you have this thick stuff and that's what you've been coughing? Yeah.What kind of death? Well, it's just mucus. So the good thing that you're able to cough it up. Yeah. So I'm kind of trying to figure out what do you really want?I want to get well. Yeah. I know you want to get well. But also we know that when people start feeling weak and not being able to eat, it's because, you know, the disease can affect you in that way.So your blood pressure was good today. Your vitals were good. You want to continue with treatment? Yeah, I guess so. No, you tell me. It's what you want. Yeah, I guess so, yeah. You guess so, you want. Yeah, yeah.I want to, but it wouldn't get better. But what about if it won't improve things? I don't need it yet if it ain't gonna improve. So I can't guarantee you that the treatment will improve things. So I don't know that. You don't know it. Well, so I gave you the treatment three weeks, a few weeks ago, and you got really weak and you are notand staying in bed all day. Yeah, I was feeling better. Right. You were feeling better or you became worse? I felt better. You felt better? So what is it? So I know the treatment won't make you better. It's not going to cure you? It made me... I see clear and I wasn't... It didn't.I was able to do the things I used to. You did what? Doing some of the things I used to, like work. Then when I started taking the treatment. When you started treatment at the beginning, yeah, you felt better, but not recently, in the last few weeks. No. No, it made you feel more sicker, right?Yeah. So I, for that reason, you're not eating well, you're still not eating well. Your weight today, did we weigh you today? I don't see a weight. I don't know. Did she have you step on the scale? I will ask her what the weight was. So my big concern,My big concern is giving you treatment today and I make it worse. If giving you treatment is not going toprolong your life and make you feel better. Is that something that you still want to do? You still want to do the treatment even though it won't benefit you? Well, if it's not going to benefit me, what should you say? Okay. So, I had...It wasn't me. Rachel had a conversation with your niece. So we all see you declining, right? And do you remember my conversation with your niece and your sister last week? No, girl. Okay. So I said, you know,you are declining and this is something that's seen with your disease. What would you suggest? Well, if you're my family member, I would, you know,I would want to see you stronger before saying I should give you chemotherapy. But if you feel you want the treatment, that's your choice.It's not mine. Well, it doesn't make me feel better. What do you need to take care of? There you go. So that's the way I see it. Yeah. So I think I need to call to talk to your son. Okay. I need him to... I need him...You're scheduled with Dr. Banerjee on the 3rd.I can't sleep. Everybody says I sleep all day, but I don't. I've been laying there while I woke. So they think I'm asleep.Let me call your son. He's at work? Yeah, he's at work. What time does he get off? He gets off at 2 or 3. Do you want me to call him or just speak to your niece? Call him later.Call him later. He has a better idea what's going on? I don't think he does because when I spoke to him the last time you were here, he thought you should be, your disease is curable. And it's not. Did you, anyone say it was curable? Not to you. Soyou understood that what we are doing is to prolong life but not to cure the disease correct? what are the things that you feel like you need things that you wanted to do in life that you still want to do well that's how well no no noNo, no, no, no, no, no. I mean, yes, but work is not the most important thing. It pays the bill, but what are the things that you... Would like to be doing? Yeah, you would have liked to accomplish. Enjoy life. Yeah, and how is enjoying life for you? Having fun with my kids. Having fun with your kids? Okay, like what kind of things would you do with your kids?You face the world and you walk. But bow back to what? Yeah. Okay. Anything else? You wouldn't be able to do that in this condition right now. Anything else that you enjoy? How many children do you have? I have three. Three boys and a girl. Where is your girl? In the...She's in New Jersey. When was the last time you saw her? She was here a month ago. She came to visit. You have grandchildren? Does she have children? How many? One. Okay, that you know. How old is she?You have a 27 year old child? Look at my son. How old is my son? How old is he? He's almost 57 years old. Okay. But you said your daughter is 27. She's older. She's older than him. 27? She's older than him. Melvin is how old?Melvin is, uh, he's old. He's in his 20s? 30s? He's in his 40s, he's almost in his 50s. Okay. You're in, you're 72. Mm-hmm. Right? What? You're 72. 72 years old. So you had your daughter when you were in your 50s, 40s? Mm-hmm, 40s now.Yeah, okay. So anyway, I'm glad you saw her. And where are your other two boys? Right here. Where? San Diego. San Diego, you see them? In Melbourne and Marvin and I don't see them. How come? I see them in New Jersey. You don't live here.He doesn't live, you don't think he lives here? No, he's not even here, I don't think. When was the last time you saw him? When the baby was here. Oh, he's not from the same mother with the other ones? Okay, all right. Makes sense.sister in Las Vegas yeah did you call her yeah why I don't need her yes you need to see her I don't need to see nobody you okay you don't need to if you don't want to see them but if you wanted to see them this is the time to spend time with your loved ones right if if you have people who are important in your lifethis is the time to spend time with them when you can sit with them like we are seated and have a conversation and enjoy each other's company not when you become very weak and you know you can't do that so you know I hope you have your affairsin order. Do you? You do? Okay. And your family knows what your wishes are? Okay, so do they know whether if anything was to happen you want to be resuscitated or not? Okay, so then we need to fill those paperwork.Because if anything happened anywhere, then somebody needs to be able to say this is what your wishes are. So I really want either your son, it's important that your son is there. I gave him the phone number for the palliative care to call.I gave him the phone number to call palliative care and schedule the appointment, but he hasn't done it. What is happening? Palliative care, there are people who will help you manage symptoms, you know, like the pain, sleep, things likeall the symptoms you're having and then it will help you fill out the paperwork that you need to fill out like you know making your wishes known yeah things like that and then they need to be able they will help your family talk to your family so that they understand where you are in terms ofof your disease progression and in terms of what your goals of care are, you know? Like what you, for example, we just talked and you said, if I give you chemotherapy today and it's not going to help. What's the use of taking it? Yeah, you said, what is the use of taking it?Correct. I'm sure you have, because you've had to spend some time recently in your room. I know you've spent a lot of time by yourself at home. What have you been thinking about? A lot of things. Like what?Anything you'd like to share with me? My family. I miss my family. You'll miss your family? My family and things that I wanted to do that I didn't get to do. Okay, what things would you like to do with your family? Just enjoy them. Enjoy being around them. Okay. You still can. I know. You still can.Yeah. I think that happened. Yep. You still can. What else? You have grandchildren? Yeah, they're grown. They're grown? Yeah. Doesn't your niece have little ones? They're grown. She doesn't have little kids at home? There are no children in your household right now?So who lives in your household? It's me. Tina. Tina? And your sister? Also, it's only three adults. Okay. I think I asked you this. Do you belongTo a faith community? Yeah. You're a Baptist? When was the last time you went to a Baptist church? A month ago. A month ago? You should call your pastor. You should call your pastor and have a conversation with him. Yeah. Yeah. Yeah.Okay. You'll do all that? So... I..." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 30 year old female here for a second post-op appointment. We had planned to do a revision ACL reconstruction, but at the time of surgery, the prior ACL was actually noted to be intact. She underwent a small lateral meniscal debridement. She has been in physical therapy working on her range of motion. She still has a slight deficit in terms of her overall flexion, but overall it is largely restored. She has minimal complaints and has been working hard in physical therapy, period, new paragraph, right knee exam. Range of motion is extension is zero, flexion is 130. The remainder of exam is deferred due to virtual visit. Period new paragraph assessment and plan. Larissa is a 30 year old female here for a second post-op. She, we had planned for a, we had planned for, Acl revision, ACL reconstruction, but this was aborted due to finding an intact ACL intra-op. She is now just pushing forward in physical therapy. I would like her to continue along with this and she will only follow up with me in four months time period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hey from Dickens and Dickey, and I'm Makenna McGowan. Makenna is a 32-year-old female presenting today for follow-up on her right knee. She recently underwent a PRP injection on December 5th period. As a review of her history, she has a history of a subtotal meniscectomy and microfracture that has led to pretty advanced lateral compartment collapse and early... arthritic changes in her knee period. We have been talking about potential surgical interventions, but again, given her young age, none of these are ideal. We made a decision to proceed with PRP as an attempted bridge to buy us some time period. Overall PRP actually has been working well. She has been able to get back in the gym. She has been able to get back onto the leg press and so far has been okay with that with no flares. The pain that she was having with day-to-day activity has also resolved itself at this point. Period. She is overall very happy with her interval progress period. She has made a decision not to go back to either running or the bike. She has started swimming and she notes that that seems to also be improving her overall symptoms and she notes no flares or issues with that. Period. New paragraph. Right knee examination is deferred today due to virtual visit. Period. New paragraph. Assessment and plan. McKenna. Comes in today for follow up on her right knee PRP injection. She's had a great result. She has had almost complete resolution of her symptoms. She is really avoiding any impact type activities and that also seems to be helping. She is overall pleased with her interval progress period. We discussed as long as the PRP is working. I see no reason for any thoughts about any surgical intervention. She agrees. We'll plan to see her back as needed in the interim period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "Saya akan letakkan buku ini di dalam video ini.Actually, to be honest, I'm not a good speaker. I'm not a good speaker." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "Presents tape for followup of left great toenail dystrophy with likely new proximal nail growth. And she knows this started at the end of December of last year. She did not recall any injury. She still feels like the nail is not growing. She notes it has improved, but has some burning. She had two occasions of drainage within the last few weeks or so. She notes it does notlimit her in any activities. Exam, palp holder cells, pedicel, posterior tibia, pulse to the left foot. There is left grade toenail that is starting to loosen mildly with new proximal nail growth noted. There is no significant inflammation of the proximal nail fold without any redness, warmth, or edema. Assessment, dystrophic left grade toenail with likely new nail growth. Approximately, this is likely secondary to unrecognized microtrauma.that caused the older portion of the nail to stop growing and now subsequent new nail growth. There is resolution of inflammation in the proximal nail fold and no sign of infection. At this point, we'll continue to monitor for outgrowth as she was offered a bulge in the nail, which she declines. She'll monitor for signs of infection as well and contact the office should this be noted." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Personal review of orthopedic note from 21821 demonstrates Achilles tendonitis and mid for arthritis right. At this point felt no need for surgical intervention. He had been treated with physical therapy and walking boots. You Friday Monday comes again pretty quickly Well, I understand you, you got a, I was looking in the chart a little bit, but do you have a knee replacement coming up potentially on the left side? Okay. Actually, this was the first one. Okay. So this one's planned hopefully in January next year or later this year. Okay. So recovery has been, it's been pretty bad with my knees. Yeah. Well, this foot is really screwed up. I had hip surgery and then I tore my Achilles. I mean, it was good. Don't get me wrong, it was great. But they had to take my tendon from my big toe and come up through my heel. So the heel's numb. I swear I have neuropathy. I don't know. My feet are always in pain. Even just sitting here, I can feel it. It's not like they're just sitting there. It feels like there's some pressure on them. This one especially right now. It's really weird. The left one. I was diagnosed with leukemia in May so I don't think it probably has nothing to do with this whatsoever, but I think I just tell everybody. Okay. Doctor wise. Yeah. Has any, had you ever had nerve studies, anything to look for neuropathy? Or no. Okay. No. I, well, I did years ago for carpal tunnel and all that and arm stuff. Not for the legs. Okay. I was just looking in here. Well, they did muscle. some type of muscle tests like in my calf muscles. I think years ago I thought the doctor thought I was losing muscle mass or something. Okay. So they did that testing. Okay. That was like years ago. It hadn't been in the 90s. Are your feet worse when you walk or does it not matter? Yeah. Okay both of them? Can you push against me? Any weakness? I don't think so. It's a combination of my knees too. I mean, I hurt every step I take right now. I've just been used to it for 30 years. I stopped playing softball when I was 35. And my knees have been bugging me since then. It's pretty much hereditary. Well, let me know this doesn't hurt I just want to know if you feel it. Yep Yep Yep Yep, a little bit That I feel that coming that toe This big toe is like constantly numb But I just noticed there's a blood blister on the inside or a blister right there and never notice that before Yeah, so it's constantly running on that toe Okay, and I I've clipped the ends of my toes cut my nails. It's tough to do Okay, because of the I don't know if they're considered hammer toes or not. Yeah, you do have some definitely some Some hammer toes where the toes kind of claw or curl. Yeah, my nails have actually like come back But the this one there It's like See how it's pointing right there. I have a tough time cutting it one and then that's I've nicked that toe several times. Okay Do you feel it when you do it? Because so one of the the the problems that happens here is he took the one tendon for the for the big toe in preparing Achilles. So now the tendons for these toes, even though there's a separate tendon that gets all four of these toes basically, it branches when it comes from one stem. So they try to make up for the lack of strength here and the toes will start to claw or curl. From the standpoint of you don't have to do anything about that, you could, tendons could all be lengthened under the toe, not farther back where they're working, but essentially they're just, you make a poke and cut the tendon and let it lengthen to reduce some of the curl. The problem with that is over time, they still want to kind of curl back on you. So at least as far as that goes, that's an option depending on how much it bothers you. I know looking back at some of your x-rays, you've got some arthritis I didn't use inserts. I had a bone spurt, heel spurt. Years ago I had cortisol done and I had heavy issues. Yeah, and that's what you get pain into is is it through this part of the foot or oh, yeah because we could depending on your Thought process right we could revisit inserts to see if those would help. I know you've been through that already We could consider steroid injections into those areas to see if we can get rid of some of that pain Just like you know, I know you've probably been through with the knees but similar idea, right? How long can it last? the flip side to the insert part with a formal insert with like a built-on arch is there is some evidence that some people will do well with what they call a carbon fiber plate but it's it's a thin rigid plate that goes in the shoe okay yeah so so that some people have gotten some relief with that so that's options there and then on the other one like you were mentioning about the potential neuropathy you certainly that can cause pain a lot of times just like you're saying, you hit right on it. One of the things that I'll use to just get an idea in my head, maybe someone has neuropathy, is they'll complain of pain or symptoms when they're not really doing anything. They're just sitting there and all of a sudden their feet are doing weird things. From my standpoint, if you want to get, I'm happy to, we could get a nerve study and see if there's anything going on. What do they do for it? Well, that's the question. So the question becomes twofold. One, if it's more of a, I'll call it an entrapment neuropathy, meaning if there's a nerve that's pinched somewhere, maybe along the back or down the leg, then oftentimes something can be done to help release that nerve. If they say, nah, we didn't find any of that, but there is some nerve abnormality, then it becomes is, right, we don't really know how to, then we're just treating the symptoms at that point, which then becomes totally up to you. If you say, well, it's all totally up to you, but at that point, I had been on it years ago. It took me off of it. I'm on deloxetune. That's supposed to be a pain reliever, I'm sorry? frequently now now that there's kind of narcotics have gotten about wrapped in general. So it's being used you know more broadly for other costs. I know my wife's taking it. Yeah, yeah, some people get relief. There's newer versions of that. There's pre-gavulin and whatnot, but similar around that vein. So that could be something. And you don't have to, whatever we, you know, you could leave here today and then send me a MyChart message in three weeks and say yeah let's get the nerve studies done. You don't have to have an answer on that. I'll set them up for you and get them scheduled. And then to the arthritis part, did you think it was worth doing injections or did you think it was weak? To experiment as far as how inserts might help, I know I mentioned the plate. I could have them actually tape the foot up to act like an insert. Meaning if you felt better with the tape, you're probably going to feel better with an insert. nothing happens then we put that aside so we do a little experiment yeah exactly yeah yeah all right so I'll have them do that for you do you want me I know you mentioned that you're having you want me to clip the nails here yeah I'll get both but I know I'm not they're kind of running away from me Yeah, these tend to be the best for toenails. do in the office, just one stitch in the bottom of each toe. All right, well good luck with the knees otherwise, but I'll update you with my chart." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Anil is a 49-year-old gentleman here for MRI review to his left wrist. Overall, he has actually been doing a little bit better on the anti-inflammatory. He saw me as a new patient about three weeks ago. He had some both dorsal pain in the wrist as well as pain over the TFCC. Comes in today for his MRI review. MRI was discussed in detail with him today. MRI shows a little bit of inflammation over the ECU as well as... some inflammation in the TFCC, but no significant tears in either structure. There's a little bit of an injury to the SL ligament, but no widening and no full thickness tearing. Period, new paragraph. Wrist and lumbar exam are deferred due to virtual visit today. Period new paragraph, assessment and plan. And Neil's a 49-year-old gentleman who I've been seeing for two issues. To the wrist, he actually has already seen some improvement just on the anti-inflammatory. He is eager to... work on physical therapy to solve this problem overall. We discussed that we could always inject the TFCC, but I'd like to at least give him about four to six weeks in physical therapy before making that decision. Period new paragraph. In terms of his low back, he has now been in physical therapy over this last six weeks. His physical therapist has noted that he's not really making much in the way of improvement. He continues to have predominantly right-sided pain that is consistent and does radiate at times. period. Given this finding and lack of improvement with conservative management, I think it is reasonable to proceed with an MRI. We're going to order an MRI of the lumbar spine without contrast to Simon Med. Rule out will be lumbar radiculopathy period. I'll see you back for an MRI review." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " All right, I have Sarah here, S-A-R-A, a new patient visit for her left ankle. All right, so Sarah, how long has it been bothering you about? A couple of days because this is... No, let me say hi. Yeah. Huh? Pardon me. Hey Spencer. Hey, I'm surprised. It's like my ankle itches. Like when it hurts, it hurts to itch. Okay. And like I don't know because like what to do because this ankle is the only one that gets swollen. This one is not. So it gets swollen. Where does it get swollen? Can you show me? Like around here. So the front of the ankle? How about the outside of the ankle? Yeah, that hurts. Yeah, there are there too? Okay. And how long has it been going on? A couple months? I was trying to look through the chart a little bit. It's been a couple months. We first noticed that the one leg swells. when she went through, I want to say last year, because she had a cardiac event, palpitations. And they noticed just the one side had swelled. But then it went away. And she's been doing PT for scoliosis. And we've been noticing just that one side is swelling up. Swelling up. the other. So we went to Dr. Wise, her doctor, and she thinks it could be the ligament on the side, but she wants you guys to check it out. Plus she has Williams syndrome. With the noelastic. Kind of stiff, stiff joints. Yeah. Okay, yeah, so let me take a look for you and we'll put our heads together. Okay. And are you working on your feet or what do you do for a job right now? Um, no, she was in the day program, but when COVID hit, she stopped going for health reasons, but they haven't been able to get her back in yet. Okay. I'm just trying to figure out how much she's on her ankle and foot, right? How about exercise wise? Anything you like to do? Oh yeah, I love exercise. What do you do? Do you walk for exercise? I do like treadmill. She has a lot of gotcha appointments. and sore up. Today she's been on it all day because we went to the foot doctor and they wouldn't see her because she has straight Medicaid and they want $180 up front and I didn't have $180 up front. And she has a, which I don't know, I don't think it causes the swelling, but she has... I shouldn't actually. Let's get a more dietary kind of thing. So let me just look at this, but in terms of, so with the swelling, we're trying to figure out is it orthopedic, is it not? So a treadmill, is that how you exercise on a treadmill? Do you still do that? She starts off once a week at PT on a treadmill. Otherwise she's dancing around in a room. That's good, yeah, she's active. I like it. Always tippy toes. Let me take a look. Go ahead and stand for me if you would. Okay. So I'm going to describe my exam out loud for you and for that software. Okay. So I'm standing inspection. There's neutral alignment at the knees. There's some moderate pronation right and left, but symmetric, same on both sides. That's good. All right. Have a seat for me. Thank you. I've never seen that before. Oh, bells ring. Ding, ding. And then the left lower leg, ankle and foot. Let me just take a look here for you. I just want to make sure everything's working. Okay can you bring this up for me? Alright sir, can you bring that up a little higher? Can you bring that up higher? Good. Able to dorsiflex the ankle, the tibialis anterior tendons intact and functioning. Achilles tendon, no palpable defect, that's great. Push down for me. Yeah, so good range of motion at the ankle, that's great. And then at the hind foot, there's a little bit of stiffness with passive motion of the hind foot. And when you get your pain, is it kind of down in here? Does it bother you there some? Yeah, yeah, there's some tenders that are more in the hind foot than the ankle, mild. And then, this side hurt you at all? No. No, okay. Can I see the right one just to compare it? And this side doesn't bother you? So a physical exam with the right lower leg, ankle, and foot. Again, good motion at the ankle. There's also some stiffness of the hind foot. Similar to the other side. Alright, good. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. So that's one. When she was younger she used to wear leg braces because she always walked on tippy toes but then she discovered how to walk on her tippy toes with the braces. So they stopped losing them. So we have x-rays from today's visit. Weight-bearing three views of the ankle which are personally reviewed and interpreted and they show no acute or stress fractures, no advanced arthritis. A little bit of mild joint space nearing about the hind foot. Now with Wieland syndrome, can you actually get, what is that word that you, like for your hand, what do you have? Arthritis, right? Yeah, you can get a little arthritis, exactly. So what I can tell you is that, you know, looking at the x-rays, there's no stress fracture. I don't think it's a stress fracture and there's no old fractures or anything that didn't heal right or something. something. What I think it is, it's a combination I think more of a tendonitis and some probably inflammation some early arthritis stiffness of the back of the foot a little bit more than the ankle even. Okay and your ankle lets you do that your foot lets you do this and that's where I noticed she has a little stiffness more in the mouth. I could do that. Exactly right. Some of us can do more than others. I can do it a fair amount. So what I suggest is that, I think your doctor talked about, well would an ankle brace kind of help a little bit? I think it would, right? And I would kind of... I don't like the socks that she described because that doesn't help my ankle at all. Let me show you one like my athletes use, right? You can just use it and I'll show you how to use it. We do a lot of these and the way I would use it, that I would use the ankle brace a little more consistently. You know, you don't sleep with it or anything like that when you're up and walking around. about two weeks, okay, and then I'd use it part-time, any prolonged walking, uneven terrain, I think uneven terrain probably flares this, right, so like uneven terrain is what I would put it on for about four weeks and then kind of as needed, alright, then you kind of have something to go to if it's bothering you. The other thing to help you would be, say, should I put ice on it, should I put a heat on it, while you're using the ankle brace a little more consistently, let's get some ice. on there, okay? So ice at the end of the day, writing it down for you. 15 minutes after dinner before you go to bed, take that time, okay, to put that on there. That will decrease the inflammation of the tendons and that will be good for you. Now is she good too or just ice? Ice is better. Ice, yeah, I would stick with the ice. So icing a couple times a day for a few days and then once a day while you're using the ankle brace more consistently and then as needed, okay? And then that's kind of the key thing. I think to quiet those down. Now would any PT with that help? No, I don't think that's going to help. No, I think it could aggravate us to help. I agree. I think she's got some stiffness there. And don't fight it. So that's what I'm trying to say. So up and down is good. And even when you're working the thirst, don't be fighting this, because I think that will aggravate it. I don't think she does. Yeah. It's mostly for her bad heart. Yes. OK. Now the other thing is that when you're I was asking you about that. You probably want to consider avoiding a treadmill, pounding on a treadmill. It can sometimes aggravate things like this. Okay, so no more. Yeah, so a little bit, but you'd rather have your bike maybe. I think they did five minutes in the beginning to loosen. Right, but maybe you get on a bike instead, something like that. And elliptical machines are nice, but the pounding of a treadmill, we don't think that's very good for the knees. the ankles, the feet, the hips, you know, we see a lot of overuse kind of because of the same pounding over and over. It's better to walk outside because you get a little bit of this, a little bit of that, a little bit of that. Correct. It makes sense. Yeah, right? Why do you know? Not many. How many athletes use mainly the treadmill? Well, they mix it up, right? I'm an athlete. All right, good. All right, so I'm gonna ask my staff if you can get those ankle breaks for you and I think, again, that's gonna help you and we'll go from there." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hello, good morning. Hi, good morning. How are you taking the hydroxychloroquine? How often? Are you taking the hydroxychloroquine? Yes. How many? It's a year. What is that? Three per week. per week so like Monday Wednesday Friday kind of yes okay and you think it's you think it's any better? Si. ¿Qué están prando? Tengo approximately two semanas que estoy mejorando. Two weeks I think they have been improving. Me salir on las ultimas como unas como seis. grandesitas, but ya nada mamá me salé una chica y ya no siento dolor. The last kind of search that I had was six big ones and then one small one, but I no longer have the pain. Okay. Pero ya puedo hacer muchas cosas. I can do many things now. I can lift up heavy things which I couldn't do before. Okay. How about donation of blood? Did you do that? No. Is that what you're saying? Is that what you're saying? Oh no. La verdad, no. No vie a decir que no tu ve tiempo. You have little time, I don't know much, but I'm not there. But I'm going to be there now, at the next time." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Patient is a 25 year old female who presents her fall of ongoing left knee pain that occurred after fall while bouldering on 1-2-24 period. At that time she was diagnosed with a partial tear of an ACL, initially diagnosed as a low grade strain period. The patient has been attending physical therapy consistently over the past six weeks and has noticed significant benefits period. She no longer walks with a limp and has significant reductions overall pain period. She reports she's very pleased with the progress thus far. Please insert a normal left knee physical exam for assessment. Patient is a 25 year old female who presents for a follow-up regarding left knee partial ACL tear that occurred as a result of a fall while bouldering a 1.2-24 period. Over the past six weeks the patient has been attending physical therapy consistently and working on overall rehabilitation periods. longer walks without a limp and has relatively benign physical exam and clinic to day period. So far we are very pleased with her progress period. She can follow up with her clinic as needed at this time period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 34 year old female presenting for initial consultation. Hello, good to meet you. Yes, my name is Lindsay and one of the physician assistants here. I'm going to start by telling you a little bit about what's going on here. Yeah, sure. I think now it's in a relatively better position. So I think around August, September, I got like a bit of tension over here on the back muscle, but then it went away. I thought maybe I slept wrong or something like that. But there was this one particular position, I think at the middle of my back here. I don't know if you can see but like where the muscle protrudes out, like the center of the egg would feel. like the pain was there. Okay. And then and I felt like this is weird and again in October I've gone for a work thing to San Diego for a week. There's a lot of sitting and standing and I started getting like back then to the extent that I had to like take my hand back again and again and then October 16th. I woke up one day in the morning and then I was just doing something on my cell phone. I stood up and then I could not move like I could not move at all because hurting that bad. I could not even drink water. I could sip water through a straw, but I could not drink. My left arm started hurting. My husband was not at home. My friends got scared. They thought it's some hard thing. I was pretty sure it wasn't a hard thing, but they took me to the hospital to urgent care. They did all the hard stuff, got ruled out. But the doctor said my trapezius muscle is maybe weak. I mean, that's why it's happening. And then she, and I think after a couple of hours, even without medicine, it was still hurting a lot. Like I could not like sit. tolerable to, not tolerable, but I was able to like drink water for instance. Then she gave me an Aproxen sodium and a, and flexural. So I took them, but I read online that people get addicted, blah, blah, blah. So I only took for like five days, both the painkiller and I think muscle relaxant, maybe I initially took twice or thrice a day, but then I made it like once a night and then it became fine. And I did start doing like stretching exercises in the morning. So this October was fine. around November about a week back, and I think a week, in November for a week, I didn't do any stretching thing. And then a week back, I started realizing, okay, I'm trending towards that. And no matter how much stretching I did, it didn't work. And then I did end up with a bad back pain, not as bad as how it happened in October. So it happened over the weekend. I did have the muscle relaxant and the painkiller. So I took one one in the night. I didn't want to take, and I also started only. with the muscle relaxant curves. I took two of those and I think painkiller either I've taken one or two of those because the painkiller doesn't suit me a lot. I get acidity and all. So now it's better and I'm realizing that whenever I'm giving heat, I have that heat blanket, like whatever thingy, that it helps a lot. Okay. But I do understand like what's going on. So I can feel like if I put my hands here, like I can feel like there's a swelling, a bit of a swelling over here. which I think is maybe the key, but I could feel like this muscle part has reduced. So I get the pain starting from here, my shoulder neck, then the back of the neck. Sometimes my, it'll radiate to the hand. Sometimes not always. Okay. And are you still having that pain kind of along the scapula, lower in the back? Or is it more focused up by the shoulder now? Now, so now I only have pain here. Okay. So really just focused on the left side of the. But then if I press, if I type it, if I type it, I'm going to show you the video. If I type it here, will it be or no? No. Okay, right there. Here, like if I press a bit, it hurts a bit but not that much. But in August September, remember, there was just one spot which was hurting, but then it got recovered. But right now if I make a movement to that side, it hurts. One thing I've been doing in the night time is I have a habit of sleeping on my left. So I stopped doing that and I'm trying to sleep either turning right or like turning like straight. And I keep a pillow under my knees so I don't get. Initially I had like a linear, even my right neck actually was hurting a bit. bit today but it's better now. I feel that was more, it was temporary but yeah I still have, I can't see any turn here. And the reason I'm worried is I'm going on vacation for three weeks starting next week and I know I should be prioritising my health, it should not be surrounding a vacation and I should have met an orthopedic long back so I just want to understand like what do you think what's going on and I can still feel the swelling here. Gracias feel like there's a curve here, but this one is well done. Do you have any numbness or pain that travels all the way down to the hand or just kind of in the upper arm? No, it's just still here. Till the elbow at times I get the pain. OK. Yeah, but I mean, it's not a lot. It was a lot when I had got that back attack. I do have some issue with the right wrist, which is a separate issue, where I have a swelling. I won't get into that. Now, I was told we can only discuss one health issue. And then any history of injuries to the neck or the shoulder? No, only my mom kept on saying I remember vaguely that when I was a kid, I was eight or ten years old, I had a very bad situation. I don't remember which side or anything that I could not even more. I remember that vividly. I don't know how old I was, but that's the only thing I remember. I do have a lot of pain. I have a bad posture situation, which I'm now improving. I have been working, I think since the pandemic. If I'm not in office, I work from my bed. Okay. I just keep a pillow on myself and I'm like working. And I don't know if that has led. One thing I do notice is when I sit on this chair, I realize Miss Kim, when I sit on like a proper, proper chair, it eventually starts feeling better. Okay. But I can sense that this is like swelling. Okay. I'm in India. Kind of where you're having pain along the scapula where you're pointing to typically indicates what we call scapular bursitis or what we call scapular dyskinesia, whereas typically those muscles or the periscapular muscles get really inflamed because there's an imbalance of how you're actually using your shoulder. A lot of that's due to improper posture and kind of weakening of certain groups of muscles, doing just activities, Ron posture. or kind of strength wise, which really just aggravates the whole shoulder. I also think that probably that pain that you're having more in the neck is also muscular as well. I can't do any strength testing to see if there's any weakness or signs of if there's actually nerve involvement here, but kind of based on just what you're telling me with your symptoms, again, it seems more muscular. Yeah. Typically the biggest way to solve this is doing physical therapy for the shoulder and kind of work on getting all those muscles working congruently again. working on posture, working on strength of the upper body to make sure that posture isn't worsening it, things like that. I do think that probably working in bed may be attributing it, because it's hard to have good shoulder posture there, and there's always a lot of rounding of the upper body when sitting on the couch or a bed or something like that. So potentially just trying to get a little bit more of an ergonomic work setup may help that. And then I usually use the anti-inflammatories and muscle relaxer. I say, if we really want to... try to help improve this before you go on vacation, one thing we could try is a Medull dose pack. It's a six day course of steroids. Steroids are just a very, very strong anti-inflammatory. So I would say if we wanna try to help kind of reduce this, that's a medication that tends to help a lot for inflammation, or we can just stick to the naproxen. But again, if you're saying that it kind of upsets your stomach, potentially that's not something we can really use long term. The muscle relaxer, I really only have you use it's helpful, it is non-addictive, so you don't need to worry about that. But some people kind of have varying success. So if you're not seeing a lot of improvement from that, then you don't need to take it. But if it's helping. Yeah, it did help, yeah. Okay, then I would say, yeah, we can continue that. I'm happy to prescribe you more. Do you know what dosage you're taking? I think it was Flexeril 10 milligrams. 10 milligrams, okay. Yeah, I'm happy. Yeah, and then Aproxen sodium. I mean, so what I started doing is I started taking this like some vitamins, so I don't get any mouth ulcers and then I'm taking probiotics. So my tummy is fine. Okay. So far, that's helping. Okay. And I'm really limiting. I'm just taking like once a day because I'm like scared when I was reading. Yeah. There's also there's a medication called famotidine, which can help with the stomach upset as well. Okay. So maybe then the muscle relaxant and the. The famotidine, yeah, I can send that to the pharmacy for you as well. And I can send you more napers. And then yeah, I would say let's try to work on getting you into physical therapy. You're in San Carlos, correct? So I don't know of any specific physical therapy places located around you. We're located in San Francisco. So I have a whole list of PT places kind of near our office, but I would say just, you know, do it. a Google search, look for PT places, let us know where you wanna go and I'm happy to send a referral there with information. Our note will automatically send you all of the PT places we use, but again, it was only based in San Francisco. There's a chain called Select PT that's on that list that may have a location near San Carlos. So that'd be one to look up, it's just Select Physical Therapy. And then I would say, if we try physical therapy and there's still not a lot of improvement, it's probably worth following. up with someone in person just so that they can also do kind of full examination and things like that. But again, it all just it all sounds muscular and there's likely just kind of this imbalance that's been kind of perpetuating over the last couple months. Yeah. Okay. Okay. And is physiotherapy and chiropractor the same thing or are they two different things? They are not. So chiropractor works more with adjustments and traction and kind of massage hand techniques. Physical therapy works a lot more on strength. fitting exercises, flexibility and conditioning. And so I usually try to tend more towards physical therapy for, cause I think that serves more long-term benefits. So yeah. Okay, and I do have psoriasis, but I don't think that's connected to, no. Okay. Likely not. Do you have other joint pain or swelling? Like, do you wake up really stiff in your hands or your knees or anything like that? I mean, the doctor had ruled out. arthritis long back. I don't have that. But I do have a, I did develop like a wrist pain here. But then I couldn't wear the wrist brand. It was fine. I do have a swelling here that sometimes increases and decreases in size. When I went to my PTP, she didn't even pal, but she was like, no, don't worry. So I'm hoping it's a benign thing, but it did start hurting a couple of months back. At that time it hurts. I just hope it's not anything cancerous or. Yeah. Yeah, we're happy to take an x-ray. I would definitely try to follow up with someone in person with that so they can always do like baseline x-rays and examination for that. Okay, yeah. I mean, I can come to, maybe once I'm back from vacation, I can come down to your clinic. Okay. Just like a checkup. Yeah. Like that thing. But I look for physical therapy here. But maybe I will start my physical therapy after vacation. So is it okay like once I reach after my vacation, which will be early January. So going for a month almost. Is that okay then when I reach out for a referral? Like how do I go to do I reach out to your office or? So yeah, I would say start looking at, taking a look at PT places. Most PT places have like a four to six week wait. So if you're actually able to schedule something before you leave, that would probably be preferable. That way you can have it set up for when you come back. And then yeah, just you'll get an email from us with kind of steps on how to get a referral. So just kind of reply to that with where you want to go and we'll send one. Okay and for now. I'm applying like just a volume something I think it's a Brufen based ointment. Voltaren gel? Yes, I think I'm applying that right now. But if I say if I get again an attack like that when I'm on vacation, I just take the muscle relaxant and paint it. I can make it symptomatic, right? I don't want to take it continuously. Yeah, I think that's totally fine. Okay. And I think I have my pharmacy on record, like the CVS and Carlos. Perfect. And I will send those. things for you right now. Okay, thank you. All right, it was good to meet you. We'll see you when you get back, okay? Yep, take care. Take care. Please add a cervical spine examination. This is limited due to virtual nature of visit, but neck range of motion looks grossly normal. Rest of examination is deferred. Please send a general PT referral for left scapular dyskinesia and neck strain. Please work on upper body conditioning into activity, please send neck strain exercises. Patient's gonna follow up in one month, no x-ray needed." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Let's take a look. Do I need a shot, do you think? Well, it's really dictated by your symptoms, regardless of what I see. You shouldn't have an injection just because I don't like the look of your knee. Here, let me pull up the x-rays. Thank you. There you go. Okay. Is that an Egyptian pie? No, I don't think so. It's just a pattern. I haven't been there yet to get anything. thing I need to do is get more get whoa wait where was your actually done where was it done no it will no I left I left no I left I left a letter Well, I just only want to give. So, just an honest opinion, I have to go into politics. So the only thing you see here, this is looking at you, you can see the replaced right knee of course, and you see some mild narrowing, certainly not bone against bone, mild narrowing of the medial compartment of the left knee. This is called the lateral compartment out here, it looks fine. You have osteoporosis, is that correct? Yes. The cortices look thin and some of these changes right. here maybe due to osteoporosis. Yes. You have to lose about 30% of your bone density before we really appreciate it on an x-ray. So what are you on for the... I get a shot twice a year and it starts with a P. Prolia? Yes. Okay great. And I think my bones have gotten better. So this is looking here's your right knee that's been replaced there's a plastic button this is looking down like this. Here's your left knee that looks pretty good there's no substantial nearing so... What I would say is the best way to analyze this, have you had an MRI in the recent past? Yes. So that's the best way to look at this because I kind of had reference to one of my first notes. You had an MRI. In fact, here's the radiology report too. They said, right to left knee joint spaces are preserved. I said there was perhaps minimal narrowing. Minimal narrowing. I think we had reference to that initial note. Oh yeah, recent MRI x-rays were taken, milder, as far as horizontal tear of the medial meniscus, yeah. So no advanced disease and certainly, you know, all I see on... So the pain that I'm getting... You gave me some shots which really... help this all the way down. Okay, into the calf. Okay, so this area. The medial part. Yeah. Is that just from arthritis, you think? Well, it could be the torn meniscus, but you do have some damage to the cartilage surface, so it could be both. If you look at the model here, we have the arthritic illustrations. Normally, it has nice smooth articular cartilage on the end of the bone and an intact meniscus. Most people, those who start to get arthritis have... some tearing of the meniscus kind of goes hand in hand. So you know all we did with the cortisone injection was simply to reduce some of the inflammation in your knee that doesn't heal. If someone has a just a meniscus tear in isolation and pain we'll often do arthroscopic treatment to clean that up to take out the damaged part. It's in the setting of arthritis though if you've got damage to the cartilage surface the results are much less certain with that so we don't push that which they most of us try not to operate that. treatment. It's when you know you've been through a total knee replacement on the other side, it's when you start getting severe arthritis in the area of the joint space and damage in more than one area that you talk about doing knee replacement. I think you're a long ways off from that. Okay, so inflammation, did the x-ray show any kind of inflammation? The x-ray won't show inflammation. No, not typically. It would take a lot of swelling to depreciate on an x-ray. The MRI is better for that. And that can go up, inflammation can go up and down based on that. We said you had some tearing in the left medial meniscus, some high-grade chondral fissure in the medial patella, that would be underneath here, there, that's not so much, and then grade four where on the, underneath the kneecap, so maybe underneath the kneecap there was somewhere. We talked about using the brace and you got the, that was back, what June? Yeah, June we did the cortisone, so four months ago. Yeah, so getting the injection really should be dictated by your symptoms, not just by the fact you have some arthritis in the knee. It's not advanced, I won't give you that idea. Your right knee must have been much worse for them to do it. Well, it was broken in several spots. Okay, all right, well. And the doctor waited for a year before he would do anything to the knee because he wanted to see how it went. Okay, all right. Okay, well. Yeah, I would sit tight with that. Your best friend may well be an ice pack. I was concerned. I wanted you to limit your Tylenol intake though. Keep that below 3,000 milligrams a day. 3,000 is going to cry. Yeah, 5 is not considered good. That includes any Norco you're taking, okay? Which I am not. Okay. Well, I saw you, at least the message I got, I refilled for 10. I think you're regularly getting it from another doctor, so stay with that. Yeah, it's hard to get. Okay. Keep or stay below and don't exceed, I'll say. Yeah, and so the way you look at this, you can get up to three injections in a joint a year, at least that's my rule. And you know, so you get three tickets, you use them as you see fit. Now let's say the knee has been a little bit symptomatic, we are anticipating going on a big trip, maybe walking, doing things, come in a week ahead and we do that. Wheelchair with my husband. Yeah. I get pretty moving in the back of the truck. That's fine, put him to work. That's fine. I'm going to get him to work. I've been doing it. Okay. All right. Well then however for you. Oh, you're you're lifting it. Okay Just be travel increasing pain left knee return Or is it I think you're a long way off from having any surgery today. I would hope. Okay, yeah, no fight the urge we'll find other people. Okay, so who actually need it. Yes, I'm sure you've got plenty. Well, yeah, it's usually, you know, we'll do, we'll do five to 15 quarters injections in the knee, many of them with, many of them with involving the knee. So I'll give you a little reminder there. They'll say follow up as needed for injection, okay, but also about the Tylenol. All right, yeah. Okay. Spare your liver. Okay, sorry I cleaned you up. You too. Me too, I will, thank you. Yeah, you're welcome. Thank you. Of course. Thank you so much for your time, and thank you for doing those x-rays and giant things. Well, that's easy. I will do it too. Yeah, no, it's just not bad. I'm sure your other knee was much more impressive. Oh, let me get your reminder here. You're fine. Thank you. Thank you. Yes, it's not pretty out now. Oh, that's taking a long time. That used to be immediate. That's that's your reminder. Thank you. All right. You're welcome. The hell right. My pleasure. I will thank you. It happens. The diagnosis is left me to meet him in this. this tear on the Malaysia I did check the cures CRES platform today as it was down yesterday she has been getting 90 Norco for a month from Rosal, Karla Rosal, R-O-S-A-L, Garfield Beach, from the Garfield Beach CVS. And this was last filled for the Norco on September 18th for 20 tablets at that point. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. And this was the first time I saw this. Before then she received 90 tablets from Dr. Oh, actually 20 tablets was from Dr. McDowell, Craig McDowell, MCDOW. Then she received 90 tablets on August 29th from Carla Roselle, supposed to be a 30 day supply. And had also received 90 tablets from Dr. Roselle on July 28th. And I gave her 10 yesterday at her request, and I couldn't review the cure. She's also getting alprazolam for Dr. Rozelle, as well as modafinil, M-O-D-A-F-I-N-I-L, alprazolam, A-L-P-R-A-Z-O-L-A-M. And I don't wish to continue to prescribe this, any opiates any longer. She should centralize the prescriptions in the future. Thank you." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Shaheen is a 38 year old gentleman who comes in today for a follow up on his rib injury. Since I last saw him, he actually has noted quite a bit of improvement. He had a couple minor recurrences, but they were fairly short. He has been in physical therapy, there has been consistent general improvement and less and less tenderness in the right ribs. Again, as a reminder, he did have a fall hitting his tub in September with an original fracture. Here in your paragraph, please... Stop before and write chest and rib exam. Please note that the tenderness in the costochondral region of the seventh and eighth ribs has almost completely resolved, period. No significant tenderness throughout the chest and rib region. Period new paragraph assessment and plan as shown as a 38-year-old gentleman who had a fall and a rib fracture in September. He then had a re-event injury that caused a really large increase in his pain. After he saw me, we just decided to... slowly get him into physical therapy and get him gradually rehabbing. He has been doing that to good effect. He comes in today noting not full resolution of his symptoms, but slow but steady progress period. Plan will be to see him back as needed going forward." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Please use the final permanent stationary template for this dictation. I saw Joshua Wilson today for a final permanent stationary rating regarding his right knee injury from September 22nd of 2022. This report is prepared as a ML 102-92 final and permanent and stationary report done at your request with pre-authorization. History of injury. Joshua Wilson is a 36 year old gentleman who works as a firefighter on September 22nd. 22nd of 2022, he was stepping into his work boots while flexing his knees. As he straightened up, he felt a loud and sudden pop with immediate pain to the right knee. He continued to work his shift, however, as he was going upstairs into a house and then later downstairs, he felt feelings of subjective instability and pain. That pain continued to worsen to the point where even walking became difficult. He was placed on crutches and a knee brace. MRI was ordered. He presented to me on October 6 of 2022 for further evaluation. MRI was evaluated which showed a small cartilaginous flap on the undersurface of his patella. There were no other significant signs of any arthritic changes. Given this finding, we initially decided to try conservative management when he was initially seen. range of motion was very limited. And he had been on crutches, ambulating. We attempted to get off the crutches. We attempted to get him into physical therapy to work on mobility. That did help to some degree, but he continued to have pain. As a result, we eventually decided to pivot towards surgical intervention. He underwent a right knee patellar chondroplasty and medial femoral chondroplasty on 1-25 of 2023. Since that time, patient has been slowly but steadily improving. He went through. multiple courses of physical therapy, all of which led to slow but steady improvement in his symptoms period. He was released back to full duty. At this time, patient notes that he is completely back to normal. He is able to run up to three miles at a time with no pain. He is noting only a little bit of occasional soreness in the knee but no swelling and is performing his duties at work with little issues period. And you paragraph current complaints. Patient has no current complaints regarding this left. Sorry, there's no complaints regarding this right knee. It feels strong. He has no instability and no pain. He only has occasional soreness with more intensive activities that quickly resolves period. physical examination, please insert a right knee exam. Period new paragraph diagnosis is right knee patellar chondral defect. Period new paragraph impression is excellent result following a surgical chondroplasty. Period new paragraph disability status. At this point, patient may be considered permanent and stationary. There is no evidence of any permanent impairment that would affect his future employment. Period new paragraph work restrictions. No work restrictions are indicated at this time. Period new paragraph future medical. care. If Joshua does have recurrent problems to his right knee, he should be covered for future medical care. Possible potential treatments given that this is a permanent chondral defect could include needing to revisit physical therapy visits up to six per year. Utilization of a knee brace, possibly need for anti-inflammatories, cortisone injections or PRP injections, as well as possible revision surgical chondroplasty in the future. Period new paragraph apportionment, there's no indication. of any preexisting or associated conditions that would justify apportionment. Period new paragraph causation. I believe 100% of this injury was caused by a patient's injury event that occurred in 2022. Period new paragraph job displacement voucher. Patient is not considered a qualified injured worker. Thank you." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "Yeah. Why are we seeing him? We don't know. Oh, okay. I guess, well, we can talk about your scan. Yeah, no, that I could have done it over the phone. I, you know, actually, I just got your authorization and that's why I wanted to get it scheduled. So sometimes they will have you see me before the treatment. Anyways, the good thing is your scans were looking good. There was no, there was nothing there.We'd expect it. How's the mouth looking? Better? This will take care of it. How much of the steroids are you using right now?You probably will need it longer. Who is doing this? Boswell. Boswell. So I would continue the steroid. You will need it on an ongoing basis. By the time these treatments kick in, Nishan, it will be probably a month. Okay. So my suggestion is you will probably, maybe not such high doses. You will need something on an ongoing basis. Okay. Typically, we'll give you a month on this. When are you seeing Dr. Boswell again? I was going to tell you.follow up at 9.15. Okay. I know they're trying to infuse and I don't know if I should keep that appointment. Well, just tell them unfortunately we do need infusion and just tell them, hey, listen, I will be occupied in the infusion. Can we set it up later? But tell them that I, doctor, I just starting the infusion and Dr. Gupta thinks it'll be four or six weeks before it kicks in. So typically what we will do is we will continue on the steroids. Maybe you don't need such high doses. Dr. Boswell,I'll give him a call as well and then have you get some refill and if you're not getting it let me know we'll give you some refill we can slowly cut down so right now you're taking what five tablets yeah so what I would do is and this is the type is me I know he likes to do it himself I would continue with after infusion maybe two tablets for two weeks then one tablet for two weeks and then half tablet so slowly come down by the timeOkay. So that is usually the method. Okay. Yeah. Just tell him this is what it is. Yeah. Yeah. Tell him I cannot see you Friday because we are starting today. Now they're trying to actually give both the drugs in one day. If they can, we'll be lucky. Sometimes it's harder, but we'll try. Okay. Sometimes they cannot do both the same day just because too much timing. They have him down for what now, David? I don't know.Time is it coming tomorrow? Eight o'clock. Okay. It's early enough that we can try and see if we can get it done. If it works out, great. If it doesn't work out, Nishant, then we will have to split days. So maybe we'll do Monday, Friday, Monday or Friday, something else. Okay. Between the two tomorrow, but I just wanted to get you started first. And again, I would say at least have enough steroids for another five,And then by that time, you should start feeling things will start settling down. Okay. I don't need to see you weekly because you're just going to be set up on your infusion schedule. If the girls feel actually if tomorrow goes well, then the chance of you having a reaction or less, then we can probably do it together. If not, we'll split out the IVIG. Okay. If they say tomorrow, because even the IVIG I'm looking, it takes now with your 70 grams, it's going to take at least a good four hours.Then the gam the retux in itself will take another four hours. I think it's going to be split. So I don't know who did this. I purposely kept it separately, but probably they didn't realize they thought I didn't know what I was doing. Yeah, I don't think it's going to be possible. So David, can we? Yeah, let's keep it on for right now. If for you are lucky enough between thewould be might start off with first if that is completed sometimes if you don't have a reaction we can crank it up and then you can finish it up okay then we can try and do the gamma so we leave it on the schedule if it looks like it's not gonna happen which is possible then you'll always switch Friday Monday or something yes yes no we'll do one at a time the the only reason is Nishan because depending on your reactionKnow how you'll do. Okay. Yeah. So we'll give you, so we'll give you the next times in future. Let's say today we'll give you tomorrow's and tomorrow's we'll give you next week's. So it'll be one at a time. Uh, we don't like to plan out the whole month because things change. Right. And then everything is then doesn't work. Good. Uh, so looks like, uh, hopefully there's nothing else from my side. I'm really hoping. And again, the other problem is you can't be on steroids for that long. Right. SoWhich is the reason why we start this so that we can start backing off the steroids. Yes. Don't worry about it right now. For a short period, it's not an issue. It's a long-term issue. That is why Dr. Boswell is really the best person because he knows to get you here sooner. A lot of the other doctors just give you steroids and then one year later, we're in the same situation and they haven't really helped us. So that's why I think you're lucky enough to be hooked up to the rightokay so let's get started and then we'll go from there I will probably check back with you in another four or six weeks after then we are talking about doing things less often okay so David I need to see him here and in between I mean if you have an issue let me know I'm thinking it'll be fine so there's really not much for us to talk about so unless there's a problem right you're going to be here all the week if there's aHe could talk to the doctor. So I want to see him here. I'll plan to see you when you're due for your last infusion, maybe a day before, just to see how things are coming so we can plan on putting on the monthly maintenance. Okay, Nishant. I think that's all I have. Hopefully, things otherwise go well. Any issues, any on the pills, on the... You got all the medicines and other stuff we needed? New medications and...Okay, and then you got the the back trim and and Protonix acid pills all of those, right? Okay, good. Good. Good. Good. Good. Okay. I think we are all set then we'll call me if you need me Otherwise, I'll see you in about six weeks. Okay. Take care all the best. Did you need a copy for scans or you're good? There was nothing there. Yeah\n[DICTATION START]\nIn HPI, please add patient at CT scan. Chest adenopelvis down on 5, 6, 20, 24, which shows no suspicious adenopathy in chest adenopelvis. No other mass is noted. Continuing with impression and plan, refractor-billis-pemphigoid. Nishan is in oncology for refractor-billis-pemphigoid. I'm sorry, refractor-pemphigoid is involving the enormous entirety of his mouth. He is doing somewhat better now, given the fact that he is on high doses of steroids at this time.steroids and till the reduction and IVIG was will work these have been authorized will plan to start therapy at this time I'll check back with him in another week from now I'm sorry another month for an offer for the evaluation fortunately his adenopathies was reactive also cities can chest and pelvis was negative for any malignancy as I had expected\n[DICTATION END]\n" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 23 year old male patient presenting for a initial consultation of left knee injury that occurred on 3 slash 3 slash 24. Hey, how's it going? Good, good. Steven, right? Yeah. Nice to meet you. Nice to meet you. Okay, my name is Eugene. I'm one of the PAs here. So what's going on with the knee? Pain whenever I need it. So any kind of flexion of the knee. and I feel pain. And it hurts when I walk and go upstairs. Got it, got it. Was there any injury that happened? Like did you fall on it? Did you twist it? It happened I think after a workout. So I was doing- After working out? Yeah, yeah. But specifically after some stiff leg deadlifts. Deadlifts? I think so. Okay. Did you do squatting too? No, no squatting, which is not good. And then when I was doing lying hamstring curls, I could notice in the concentric part of the movement, there's- point where it was just difficult to generate any kind of force. Yeah. And I just kind of pushed through it, which I think was a mistake. Got it. But after that, like the rest of Sunday, that was Sunday, I did the workout. The rest of Sunday was okay. And then at night, I kind of woke up and there was throbbing pain in my knee. Because like... You woke up with the pain, throbbing pain? Yeah, yeah. Because there's not really a position without a pillow under it where it can just be comfortable and like doesn't have pain. So that was like the first time I had pain. And when I woke up on Monday, that pain was at intensity like... was the highest throughout the day. And then maybe like two hours into the day, it started to ease off a little bit, just as I was moving around a little more, going upstairs, walking. And then as I went to sleep, it was fine. I was able to fall asleep. But then again, like middle of the night, I wake up and it's like, I have to readjust or can I pillow under it just to ease that off. Where's most of the pain that you experienced? It feels inside a little bit, but like probably like right here. Right there. Yeah. Okay. Do you feel a clicking? No. No clicking? No clicking. Okay. Alright. Any swelling that you notice? Not necessarily. Okay. I do think I remember it feeling somewhat warm. Warm. One of the days. Okay. Got it. Has this ever happened before in the past? No. So I have felt maybe something like just pulling... slightly during RDLs but never felt anything after that the workout where I'm like oh this is like a direct like it was always just like doing okay that's kind of weird but nothing else this is the first time it's like a I felt something after the workout and dance like this I've never had anything that felt like this where it's like a wake up got it got it okay let's have you take a seat right up there um looking over at your x-rays everything's good so far I don't see anything that is jumping right out um do you working in medicine, healthcare? No, okay. Can I ask why you asked? Yeah, because you were talking about eccentric, concentric, and I was like, oh, you sound like exercise. I was like, oh, you sound like you were in PT or something. Okay, so yeah, everything looks good right now. Let's take a look. Can I ask what makes you say that? Like, is there any like typical problem spots that you usually see? Yeah, so things that we look at, right? First of all, we're looking at seeing if there's any, you know, if there are. obvious fractures, we're not seeing any of that. And then the next thing we're looking at is there a good joint spacing. So you get pretty good even joint spaces all throughout, no osteophytes formation over there. Usually that's negative, but like, you know, signs of like wear and tear, arthritis, things like that. Sometimes you can also just develop like patella issues with like a lot of bone spurring, it's right over there. Yeah, we don't really see any of that either. So as far as from what I can see right now, everything seems like. Okay. Okay. And I, yeah, sorry. Go ahead. I'll just ask at the end. Okay, no worries. Feel free to ask any points. Okay. Let's go ahead. Any pain up here? No. And then all of your spine too? Yeah, no pain. Okay. Any pain here? No. And right here? No. Okay. So that's your MCL right there. That feels fine, right? Anything here? No. Although it feels closer to where, it might start to hurt. Okay, how about right there? Is there anything over here, usually? Like right there? If I were to, like, it's hard to pinpoint, but that's like where I imagine is where the pain is, but when you're touching it right now, it doesn't hurt. Okay, that's gonna be straight in, out, and push against me. Push, push, push, push. Can you feel that movement? No. How about pulling back? Slightly. So, I think in there will be a certain position where it just would hurt more. Maybe at this specific angle, not so much. But I can start to feel something like right here. Right. And it's not like down here, right? Uh... You need to pull hard. Potentially, like right here. It feels like a stretch or something here. Going all the way down. Yeah, probably stopping about here like mainly like right here. I mean you right there. Yeah Taking here You don't look fit too much here. Okay. Let's lay down and get back. I think there's some bruising here. This is pretty normal for me. No, I don't have any. I don't think that would put a call for the bruise. Oh, yeah. Where's the paint? Like right here. It was, I guess, more generally angled. Yeah. So it's like right there? Yeah. Does it hurt when I push in this way? No, it doesn't hurt when you push, though. No, it's fine. Oh. That's straightening out. Straightening out? Any pain inside the knee? No. How about the outside? No. Any pain to the knee? A lot. And it's still right here? Yeah. No pain. Still no pain right there, right? No pain right there. Can you contract this leg muscle for me? Pain with that? No. Okay, relax. This is the lobby, right? No. Okay, tighten up. One more time. That's okay. That's okay. Okay. Okay, you can sit back up. So, multiple structure in your knee, okay, which is like your leg means, pain in the neck, those are all fine. Because you're not gonna be pain in the knee, stressing, testing those areas, okay? Well, look for the neck, that's what I was gonna ask about. Like what, what? What is the last thing to say over here? Yeah. Yeah. So great question. So things right over here, first and foremost, there is a sort of like a like a sheet of like a plexa that sits right over here in the medial side. And then you also have some cohoppus fat pad that's like right underneath right here too. Okay. Sometimes those two can become very inflamed and cause pain and irritation, which is what I think may be going on here. Cause again, you don't want to... have any pain with me testing your meniscus inside and outside. That's what you were testing. Yeah, so that's what I'm testing for. Those are sometimes the ones that require surgery, but you don't have any pain with those movements. And your MSL is totally fine over here. You don't have any swelling in your knee. Sometimes there's swelling in the knee. We might be concerned for like cartilage damage and things like that. But we're not seeing any of that right now. So bottom line is overall as the knee, like the key structures are there and they don't seem to be damaged. But you might have just inflammation in your knee that may need some resting, anti-inflammatory medication, things like that. Okay. So let's go ahead and give you a course of oral anti-inflammatory. So I'm going to prescribe you this one called diclofenac. It's an anti-inflammatory in the same class. like ibuprofen so don't take any ibuprofen water or you're taking this okay I want you to take it once a day that's right once in the morning once in the evening so twice a day for the next two to three weeks okay and then just sort of ease on the lower body exercises probably don't even do and it's probably the best yeah and then just see how everything feels in like another couple weeks we'll have to come back okay um Yeah, okay. And usually if there was an actual injury here, it would be sensitive to the touch, not just like me flexing and moving it around, it would be sensitive to the touch. Exactly, yeah. If you sensitive to the touch, you have swelling, things like that. Again, usually with a lot of ligaments or meniscus injury, they tend to have a bit of swelling in the knee. Okay. And also there's no associated injury that happened. You know, you didn't twist your knee, you didn't fall on it or anything, and it just worked. So I have pretty low suspension that you're torn or structured. Okay. Maybe torn or something. I don't think torn. Oh, you don't think that. Yeah. I don't think torn anything. I think you just had a lot of inflammation and irritation. Okay. Yeah, that was a big question mark because none of the exercises I did sounds like it could be inducing some kind of trauma in the knee. Yeah, they were all like- But the pain was just like, didn't match up with what could have caused it. So that's why I just had to kind of- Yeah, I think that's valid. There's pain, you just turning your knees a certain way. But otherwise, I think the key structures are seem to be intact. Okay, and does there any need to be any precaution on how I use my knee? Just like day to day and like how I'm walking or like striking my foot on the ground? No, sometimes you can just have inflammation just from repeated exercises. Sometimes we get enough rest between reps, things like that, exercise days, a lot of lower body exercises. You run a lot and then you go do lower body workout and you don't really get a few legs, like gens to heal. I think that can also cause it too. But nothing that we're seeing here that's like, hey, you were doing this wrong. Yeah, yeah, yeah. And in terms of intensity, that can also just be a factor of like, it can be as bad as it is now. just depending on how much information I have. Because like, I'm not, like information doesn't sound like it would be like something that would keep you up at night, but like it definitely can get to that point. Sometimes it can. Okay. Yeah. That's not out of the picture of like something that can normally happen. Yeah. Okay. But again, we're going to closely monitor this and see whether or not that just continues to get better. If it's getting better with all the time inflammatory, resting, then great. We're on the right track. But let's say we see you back, right? And you're like, has to be absolutely no improvement. It's so hard. It's still. you up at night. That means we're probably not seeing something that at which point we'll order some additional images like MRI and things like that. I see, I see. What would an MRI probably show? Yeah, MRI stuff basically tells us a lot of soft tissue injury that's in the knee. It could be anything from showing us your meniscus damage, cartilage damage, ligament damage, the verve flame like I know we talked about or the fat pad. Those are all visible. from the MRI that will be able to give us a definitive answer like, hey, you have this, this is the problem here. Yeah. Yeah. Okay. And in terms of like, if nothing serious is going on with my knee, we're topping in the scale of like weeks for relatively back to normal recovery? I'll say about take at least two weeks off lower body exercises. Yeah. And then see how you feel. Do a very slow, gradual return back to like lower body. Yeah. decreasing the weight by like 50% to see how it feels and it's slowly working way back up. Yeah. But okay. So, but two weeks I should see somewhat of a relatively normal return to function. Yeah. After, especially after taking the entire time, return to resting. Okay. Okay. And if I have pain at night when I'm trying to fall asleep, just like elevating it is a good way to- Elevating it, you should be taking the entire time to do that, prescribe a PQT, so that should help with some of this comfort. Okay. All right. Yeah, okay, perfect. Alrighty. So let's pick a follow-up appointment in about four weeks from now just to see how things going Okay, the only difficult thing is i'm going on a business trip to neil. Oh, okay for a second period of time for how long Please insert a left knee three view x-ray bilateral weight-bearing view. That's normal Please insert a normal left knee exam And add pain to the medial side of the patella with knee flexion and extension and rotation period. Assessment and plan this is a 23 year old male patient presenting for initial consultation of a traumatic left knee pain that's been ongoing since 3-3-24 period. The patient denies any acute trauma or injury and that the pain seemed to have came on after. Exercising at the gym. Period. Patient has no pain on palpation today and notes most of his discomfort. It's in the medial side of the knee adjacent to the patella. That is especially worse with knee flexion and extension and also with rotation. Period. I review patient's love knee x-ray today with sna shoni. Acute findings. Period. We'll discuss. that his pain over the medial side of the knee may be indicative of the medial plaque syndrome and recommend for him to rest and take oral and time inflammatory for the next several weeks period. We have low suspicions for any meniscus or ligamentous injury at this time period. We discuss with patient to refrain from a strenuous lawyer. body exercises at the gym for the next two to four weeks and To continue to monitor For improvement after an oral and time-inflammatory and resting period. Patient states that he will be an extended work trip for the next several months and therefore will follow as needed at this time period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] Thank you.\n[DICTATION START]\nyou\n[DICTATION END]\n [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 28 year old female presenting today for follow up and MRI review regarding a traumatic left knee pain and swelling that began in December of 2023. She has a history of prior ACL reconstruction. 12 years ago, a patient states that since her last appointment, she's had significant pain reduction and swelling relief. She notes that prior to this, She had not had any significant flares like this in the past. Please copy forward prior left knee examination, but note that it was deferred due to virtual nature of visit. For assessment, this is a 28-year-old female presenting today for follow-up and MRI review regarding a traumatic left knee pain and swelling that began in December of 2023. She has history of prior ACL reconstruction 12 years ago. I reviewed her MRI in detail, which shows her ACL is intact. There's a small possible medial meniscal tear. the most significantly there is significant cartilage injury to the patella. I'm highly suspicious that this is likely the cause of her recent pain flare and swelling. Discuss that due to the significance of the injury and her young age, I would highly recommend a diagnostic scope for potential chondroplasty versus and or macy biopsy. Discuss that potentially based on the appearance of the lesion there may be cartilage grafting procedures. Patient is open to the surgery. She is going to follow up next week for further discussion with our surgeon. In the meantime I am going to get her into therapy for good quad and hip strengthening to help with patellar tracking. Follow-up in one week. Please send general PT referral." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Meday Toriyama trained sleeve and has worn that but given her lack of discomfort presently she's not using it routinely. We discussed her normal activities including hiking and rock climbing. I referred her for physical therapy course and leading to home exercise program. If she has recurrent symptoms she'll return follow-up. We can review her study then and consider options such as a steroid injection potentially. Period and dictation." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "Hi, how are you?I actually sometimes I have more pain now than when I did after this surgery. I didn't have very much at all. You'll probably want to get some x-rays. Yeah. Usually the year I do for other joints, of course. All right. Well, tell me what brings you in today. Okay. Well, the day before St. Patrick's Day, March 16th. Right. I was just going to have some lunch. I was going to sit up on my sofa. Okay. Watch TV while I eat it. Right.And I just saw some crumbs on the sofa. I didn't bend, didn't do anything. And I just went like this, standing up, and I heard a pop. And at first I thought it was my knee. Right. But then I started, you know, and I knew it was in the back. So were you standing or? I was standing. Okay. And so then I couldn't walk. And there was nobody home because I couldn't. So you were just out, you just outstretched your left arm. Yeah, I just went like this. Right. And I don't know if I moved forward, but I did.So you heard the pop left side and it was right through here. So I wasn't sure I thought it was my knee, but then as time went on, I said, you know, I think it's my cat, but, um, because I couldn't lift this one up because I couldn't see any pressure or weight on this. So you couldn't wait for him to walk. Okay. Yeah. So I finally, I just kind of shuffled.And it got better. And then I can't remember if it was the same day or the next day, my daughter took me to urgent care. Okay. And just to see, you know, they could see anything, you know, blood clot, whatever. And they said it didn't look like there was any blood clot or anything like that. And that it should get better. Yeah, blood clot doesn't show up like that usually. Yeah. Cute. Yeah. So, and then I started realizing that I think it's more my calf. Right. And I've had a problem with that calf for a long time.minimum of 20 years and I've gone through all kinds of testing for it and all that and it nobody seems to be able to figure out what it was they he said that it sounded like I had lymphedema mm-hmm so he sent me to a physical therapist at st. Mary's did yes a clinic forYeah, and she said that I had all the symptoms, but I didn't have it. Huh, interesting. So, off and on over the years, it really hurts me. So, I don't know, for about a couple months, three months maybe, I've been feeling it more, and when I do, I have to kind of just sit down. Feeling what more? The calf hurting. Yeah, okay. And it's like, it's like I want to stretch it, and I can't. That's how it's always been. Okay. So, I don't know if I did something to that, butI can't bend my knee very well. I can't pick up something because I can't bend. All right. Let's take a look. And I can go like about to here before it starts hurting. About to, sorry. Maybe minus five degrees there. Okay. And then there is a muscle. Does this hurt as I press in here? Not in the back, just on the front. All right. Stay away from the front. Okay. So not tenderness in the back. How long ago was yourI'll tell you it was before 2009 because I went to Alaska and I tweaked it. It was a day I was leaving to come back, but I was fine. So never really give me problems sometimes if I don't watch it and I'll tweak it and then it goes away. It's going that far back, unfortunately. Yeah. I know it was before 2009.Yeah, your records go back to 2008. Just one, though. And nothing until 2014, it looks like. Let's look at one other place to see if there's anything old. There's 2010. Oh, it goes back to then. Not quite. There's Dr. Doman's notes from 2010. All right, let's see.Take a look. And then come on over here. Lie down on your back, okay? Oh, and then I fell, but this was in February. It didn't bother me at that time. Right. It's a good thing. It's part of my house. Well, your face looks none the worse than rare, fortunately. Yeah, luckily, yeah. It was very lucky. So let's bend this up.I have about five degrees of extension. Bend your knee, bend your knee. Yeah, flex it. Can you bend it? Is that hurting you to do that? A little bit. And where does that hurt? All through here. Well, it's kind of capped at knee too. And then relax. Let me bend your knees further. Does that bother you? No, not anymore. Okay. No. Now let's see. The cap, again, the cap's not tender. Is that correct? Yes, it's not tender. I don't feel it. Okay, so no tantalization.your support or services and order we probably don't expect your report or report for the sort of looking for ok so let's have you get some x-rays down the hallway down up the trees both your knees actually routinelyOn the other day, I almost went flying into traffic because I went down the curve on this leg and I didn't get out. I went flying. You just slow down, don't we? Yeah. And I had stuff in my arms and I said, oh my God, jerk back or something. I was on El Camino in South City. Busy, busy street. Yeah. I was leaving the Maltese club. Were you the secretary or something like that?Come on downoff we goThank you.E aí E aí E aí E aí E aí E aíThank you.Thank you.Thank you.Thank you.Thank you.Thank you.Thank you.Thank you.Thank you.Thank you.Thank you.Thank you.so" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Patient presents clinic for initial consult of right knee discomfort. That started approximately a month ago period. The patient denies having any sharp pain or traumatic injury to the knee period. However, he reports since initiating running again after a two month hiatus, he has noticed some tightness and discomfort within the right knee with running period. It is noted that he has never experienced this discomfort in the past. and wants to ensure that he is not harming himself at this time period. Please answer a right knee physical exam with benign findings. Please answer a right knee x-ray with benign findings. First assessment plan patient presents to clinic today for initial consult of ongoing right knee discomfort that started approximately one month ago period. Both the patient's x-ray imaging and physical exam are relatively benign in clinic today period. Discuss with the patient that I believe he's dealing with patellofemoral syndrome likely from increasing his running mileage after taking a break from running over the past two months period. Discuss with the patient that I will send him patellofemoral exercises as well as a referral for physical therapy period. Discuss as the patient is not experiencing any intense pain. I do not believe he needs to initiate any anti-inflammatory treatment at this time period. The patient agrees to this plan and will turn for follow-up in six weeks to evaluate his progress period. Please send a referral for a general referral for physical therapy for right knee patellofemoral syndrome and please send education on patellofemoral syndrome." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "No habla inglés, puro español.Puedo hablar español. ¿Cómo se siente el día de hoy? Este, lo habíamos visto porque tenía las células elevadas, pero no veo, no veo... ¿Hizo prueba de sangre? ¿Cuándo? No lo tengo. No lo tengo.Bueno. Pues es la única razón por la que la veo para revisar cómo está la sangre para estar seguro que no necesita mi ayuda. Déjeme, voy a colgar y voy a volverle a mandar el link para tener toda la información que necesito, ¿ok? Ok, gracias.I don't have labs. I cannot see a patient without labs. I see a patient for hematology. Without labs, it's like being blind on a patient. And very simple. I just called her, and she says, I did labs a week ago. People directly figure out that, oh my God, what is that today? I did labs today. I haven't done any of the lab work. Okay.It's a 47.Yeah, that's what I call you.I'm yeah I'm on your mom's I'm I'm I'm I'm I'mI will just wait.okay do that just to tell you that I made a payment agreement with the Texas shit but we need to follow up on the the extra charge they are giving us because the house is worth 850 or 825 not one point whatever so they gave you some we need to follow up on thatΕυχαριστώ πολύ.Okay.Thank you.TidningThank you.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.Okay." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hey, how are you? Good, how are you? Good to see you. You're alright. I don't want to commit to the surgery and have it, so it's an easy statement to make. Oh yeah, well it's going okay. Alright. It's in valleys. Yeah, well it's normal, especially in the first two months. have some ups and downs with this. There's a major, like little bruising and then it just got bigger and bigger and bigger. And then in the past two days it's like disappeared. Yeah, so bruising just follows a path of gravity. So the problem might have been up here, but it's moving down with gravity. But you see, it does. So I'm a little surprised. I'm not. Pretty much. Yeah, go easy with the motion. Just meaning, Always respect the discomfort. I'm learning. This is still early days with this. And what happens, the important thing for you to understand, one of the important things to understand, is even with this being repaired, look at her cuff tear, the repair weakens in the first month. So it's weaker a month after surgery than the day after surgery. Because what has to happen, new blood supply has to and start to form it allows us to heal but so you know especially in the first eight weeks you gotta be careful with this and you're just right from this yeah so I'm happy if you're just doing this business if you're coming over here I want you doing the wall climbs but supporting the hand I don't even let you hold the four go through the shoulder work equals force times distance if you're doing something out here that's of course a lot of stress on the repair yeah so go easy because the repair can fail so come over here let's let's watch you do this just put use the other hand we want you to get your motion back but i'm not worrying i'm not worried about strength now we try and strengthen you're going to undo the repair actually you're doing very well with motion when you're at at least 120 degrees i want to make sure in a month you're at least 90 okay so you're doing fine in that regard put your elbows at your side I'm noticing like multiple I haven't seen this muscle in a long time. Well, your biceps, because it was out of the place, it was hard to use it because it's just aggravated. When we cut it up here, you get a little more fullness down here in the muscle. But hopefully, if you can use it, I don't mind you doing this business, I just don't want you doing anything where you're rotating out or you're doing unsupported motions. So always support the hand, especially these first two months. Yeah, even like that. Yeah Yeah, so support it do the motion but support it with the other hand That's really important because we don't we don't want to wait to get frequent flyer miles here Okay, I don't there was no way going back to OR to deal with this because the repair failed But the incisions look great, this is still early days We're planning on that, yeah. Shortness of breath, a little scary. Yeah, if I had panicked it would have been bad. But for some reason I did not panic. But because I was operating room so much. Now, I'll give you a referral to physical therapy. You would start this in about eight weeks out from the surgery. So you could call them now, because it seems to take a month or so. Where have you done your therapy in the past? Uh, Davies. Watch your envelope here. Don't want you to lose that. Davies. At first, it'll take at least a month to get in there. Yeah, I mean, I'm going to do that coinciding with my back. Okay. Okay, all right. So let me give them this prescription. I'm wondering if you can give me a prescription for a pain meds. Okay. Just for two days. Okay. Because my regular pain meds. They're out of the payments. You're a doctor or the pharmacy or what? The pharmacy, well agree. Well what do you normally take? Oxycodone, but I'll take the same. Just rest every day for sure. Okay, what is one treat besides Oxycodone? You're taking hydrocodone, meaning Norco? Hydrocodone, yeah. Alright, and what dose of Oxycodone do you take? It's 40 milligrams. It's like 20, oh you take two 20s. Yeah. take Norco like two tens. Not Norco. Okay, Norcos hydrocodone. That's why. That's why I mentioned. Let's see what your allergies are here. What? Alprazolin, deloxetine, other. Is there another? There's tramadol. No. And there's dilated. Norco would be it. But for some reason I'm thinking that's. It's not listed as one of your allergies. Okay. Yeah, it's the same class. Dilated, oxycodone, dilated is hydromorphone. Yeah. Norco is hydrocodone with Tylenol in it and then you're Tylenol with codeine and there's tramadol. It's kind of what you have. Yeah. There's the oral opiates. Yeah. My yeah. Let's do the narco cuz I'm actually wouldn't mind. Sorry. Um transferring the hydrocodone. Well, yeah. But talk to you. Yeah, you'll have to talk to your primary. Yeah. Or whoever's normally prescribing it. Yeah. So, I'll give you twenty of those for now, okay? Yeah, it's just for two days actually. Cuz I'll pick up my Prescription Friday, hopefully you have it but apparently there's shortage. Yeah, she never knows the firm out Okay, there we go, so Like sweeping it's giving me the same kind of problem Well, yeah, well you could There are some lighted patches you can put on at nighttime. Those are over the counter. You can try that and make sure you get a good ice session in before you go to sleep. Sorry, the DVA is making me go through all these steps here. I wouldn't ask you for this, but it's just to transfer to another... Which pharmacy is Safeway and 2020 Market Street? That's not Diamond Heights. Walgreens. No. I think it's on gold rush or something. Diamond Heights. It's like gold rush I think it's called. Nope. Maybe it's Walgreens and Diamond Heights. No, it has to go to specific pharmacy. It's all electronic prescribing. All right, Safeway and Diamond Heights, let me look it up. Do you actually, I don't even think of the other pharmacy when I think of it. Oh, okay. Yeah, there's just- Church, then I'll just do the main one on Market and Church. Okay, that's it. Yeah. It's a smaller one. We have a Walgreens up there, All right. 2020 markets rate, that was what we talked about before. Okay. You're not taking fluconazole right now, are you? No. Okay, that comes up and it's an interaction, that's why I asked. So it does not, yeah, that's an antifungal. I don't know. I did it one time. Yeah, we're not taking it now. So, it doesn't matter. Okay, there we go. I'm going to have my. You need a valid. That's right. Let's see. Okay. I mean any Any any open you take causes some respiratory depression potentially Shouldn't be an ongoing issue. Okay, so that's got centered and then When you get back and See me in about you know month and a half or something and uh... this or let's have to look for what's best for you but don't start the therapy you know about eight weeks post-op we were worried about that you know i don't have a website has been weak and uh... i'm wondering if i've had like that some kind of muscle problem. What was the surgery you had up here? It's clavicle. You had a clavicle fracture? Yeah. Nothing here. I know I used to be a leader and I couldn't carry trays in this hand. Right. Which is traditional of course left hand. Right. I would have to do it on my right and I just could never get strength from this left I thought it was from my back, but this is even before my back. Probably not. But see, when you do the therapy, you know, what's good for the goose is good for the gander. Do that on the other side as well and see how it goes. If there's ongoing issues, then we can look at the left side of course. Yeah. Do you think that you can see if there's something more than just muscle issues? Well, yeah. I mean, they're going to give you a program to strengthen your shoulders, period. So that should carry over to the other side. If that's not helping, then we can investigate more. But try that as just your first step. Okay, so we've got a therapy prescription for you. We're going to have you follow up in a couple months. Keep an eye on this, but just go easy. Support the right hand as you climb the wall, etc. Okay, we'll see you within about two months. All right, we're going to work. The prescription is going in. Hopefully you don't have a shorn back. That's true. Okay. Let's do a reminder here. There it is. I'd like to see Mr. Hig in about two months. Okay. Here's your PT description of Mr. Hig. Thank you. And here's your reminder about the, uh, the printout that you've made up of four pages. This is the main thing is. Okay. Okay. Thanks. I'm going to do the 24th at 3pm. And then I can write one. Hello." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Bruno is a 24 year old gentleman here for a right knee MRI review. He saw me as a new patient after some knee pain that started after some fairly intensive running in August of last year. He has been doing some at home exercise, which hadn't really been helping and had continual pain in and around the patellar tendon. Given the longstanding nature of his symptoms, an MRI was ordered and he comes in today for MRI review, period in a paragraph. There's no significant inflammation in the patellar tendon. There's no evidence of a significant chondromalacia in and around the undersurface of the patella. There is some evidence of a moderately thickened medial pylchia, otherwise no other significant findings are noted. Period, new paragraph, assessment and plan. Bruno's at 24. very old gentleman with right knee pain, MRI shows no real significant findings other than a small medial pleica period. We discussed that this is unlikely to be the source of his current symptoms. My recommendation is to push forward in terms of physical therapy. He has his first visit coming up later today. I'm gonna give him the next two months to see how he recovers, and we will do a virtual check-in at that point. Good." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Well, hello. How are you doing? Good. How have you been? Good to see you. It's been a while. Yes, very much so. All is well? All is well. Well, it's better now, you know, after I had COVID, I noticed you're not wearing glasses anymore. Oh, it's been a while. Yeah. Yeah, yeah. Did you have surgery? No, I had the lens implants. Oh, replacement. Like cataract. Yeah. Because I was having both, you know, near and near. in far vision problem. So I was tired of using three glasses, one for driving, one for reading, otherwise. So this is so nice. But what did you, did you get the three? Like the read or just the far? These kind of are newer that focus lenses, yeah. You only qualify if you have both far and near vision problem, unless you have cataract. Those are different, you know. similar lenses. Insurance doesn't cover it, so I have to pay for it, but it's a blessing. I mean, it made my eyes dry forever. That's the drawback, I didn't know that, I wasn't told. But eyes are dry, so I have to really blink. Unless I put, you know, those. Restasis. Yeah, like daily, and I'm not a good patient to put drops every day, I just can't do it. You know how I do mine? I have them in my drawer here. I am my nightstand. And I get up, before I get out of bed, I put them in my eyes. Yeah, but you're a good patient. And then when I go to bed, I put them in my eyes. And that lasted for a couple years. Now I'm starting to forget because I'm tired of doing it so much. But so I carry them with me. I put them in a little, maybe just a little tight drop. But I go back to my regime because it works. I get up in the morning at night. and you know, it lasts for 12 hours. That's pretty good. You lost weight? I lost weight. You tried to? I mean. I did, I did try to and I modified my diet. I threw out a lot of junk. And I stopped eating a lot of pasta, fried foods. You know, I just started eating more healthy. I didn't. exercise because after COVID I'm still tired from that. But, you know, I was telling Seth that I'm doing this volume now and I've been doing it for ever since I had COVID, before I had COVID. And right after I had COVID, that was like a year ago in November. Right after I had it, I took the test they wanted me to do. And before I had also taken a test when I was healthy. after I had cancer and I was doing real good, I was healthy. You're talking about a test for COVID? No. Oh, which test? No, this was just a test to see what is my internal health like. Oh, I see. I see. So I did that and I was eight years younger than I before COVID. After COVID, I took the test again right away because I want to know what's going on in here because they give you a blood test and they take your BM. So they said I was, now I was 78 years old, no 76 years old, internally from COVID. So it affected my mitochondria. So now I just took it again in November, early the 6th actually. And they said, oh you're doing really good. You're 69 now internally. So and they give you, it's all herbs they give you it's designed for your blood type for your whatever's going on with you and that you they this is a long thing long test you have to questionnaire yes it's called biome and so I'm doing but and then I had in fact brought this so I could show you And it's herbs. And then they also give you a pre and probiotic, which is like a slender little packet. And you take that. If it bothers your stomach, they say take it before bed. So you take it with food? Yeah, I take it with food. There's eight capsules. I take it in the morning with breakfast. I usually have a shake. I don't I eat a piece of toast and then I because I'm not really big on breakfast oh that's another thing I started doing is intermittent fasting intermittent yes fasting I did that and I've been fasting for like 12 to 17 hours hmm so I did that and that really helped me a lot I'm also started taking it's called because I'm going in fact today I'm supposed to go to meet pro therapy because I hurt my shoulder and they're gonna help me do that. But they're gonna get me on a exercising regime so that I'm taking wizard oil, which is like a molecule, like a, it looks like a soccer ball. So, and that's in oil. It's from some scientists. It says here about your insurance, what's happening with the insurance? I'm. 65 years old so I'm doing Medicare now so I'm on Medicare and In fact my insurance man said He just just sent me a packet that said you need to renew this now So that's one of the things I have to do today is I have to fill that out The advantage is we are able to do a PET scan We can do the PET scan now We can do it in who's used to deny it, remember? We can do the PET scan with Medicare. I could only do it like one every other year, or one a year? With two Medicares every 90 days, but we don't need to. It's been almost a year, January was your last scan, so we'll do it anytime. We can do it in December and then discuss it. That will clear, because you're coming close to four year mark in February from your last treatment, which is awesome. And when we. When was the last colonoscopy? Has it been more, a couple of years now? Two years, I think? No, no, I don't know. I think so, I think the last time I had it was over a year, because it was before I had COVID, so it had to be a year and a few months maybe. Ectar. Yes. Yeah, I'm kind of afraid to go back to him because the guy who put me out, theosa vitro papilla. anesthesiologist, he gave me something that actually burned my body and I was flapping like a fish screaming and then he put me out. But and then I was real groggy and he had me sign something I don't even know what it was. And I thought oh he made me sign a waiver that's what it was probably I don't even remember I couldn't read it because I was out of it. So come up here. But yeah so I'm kind of afraid to go to Abtard because you know if he's hiring people that do that to his patients, I'm really not, I don't know, maybe I'll go back to Dr. Lee. Dr. Lee was really, how's that? Is that okay? Yeah I have not heard from any patient. I see a lot of patients from Abtard. Oh good. I don't know, maybe that guy had something against him. I don't know. I think, I mean, you don't like my kind of person? What's going on? Deep breath. We can reset this because it's a little hot anyways. Deep breath. Again. All right, so we'll do the scan if there's any question that I'll have them do the scope now otherwise we can wait. Okay, what does my liver, remember it was fatty before, I was worried about that, so I started paying attention to that, did it change at all from before? So the only way to tell is to do a special ultrasound called a lastography that will tell you the stage of fatty liver, how much fat there is and otherwise you can't. The basic scan will not tell us the difference because it may look the same even if it's improved. And the blood test the same way, they may go up and down depending on the inflammation in the liver. But with your weight loss and eating habit change, I think that definitely will help the liver, yes. Yeah, yeah, yeah. Oh, because I'm having a pain. over on this side in the back. You know this is and I don't know if it's nerves because I had no well it does hurt right there but that's where they they took out a cyst here and I'm thinking maybe they cut a nerve or something I'm not. Or maybe it could be scar tissue there. Yeah but it's like all it's like every day every day every day. Yeah well. Lungs are clear, listening to them, so that's good. It could be muscular pain, but we're doing the PET scan. If there's anything, it will pick it up. Otherwise, you may have pulled a muscle. That's very possible, so I may have to do a massage. I think that would help. You know, some exercises, so I think that would help it. I'm going to tell whoever the person is today about it and see what they say too. Maybe they can give me exercises. Well awesome, so I will, so far that's back. Kidney liver function is not back yet. It'll be back later in like a couple hours. Oh okay. So if there's anything then I'll let you know, but otherwise the white count, the hemoglobin, the platelets, all that looks good. Okay. The PET scan, once we get authorized, well we don't need authorization, so they'll schedule for the next two, three weeks. Get the scan done in December sometime, and then I'll call a few days after. My daughter is getting married in December, so I'll be gone for a couple weeks. Oh congratulations! Thank you. Thank you, so Yes Thank you. I'm blessed. Yes. Yes, so that happens. So so I'll call you with the results though. Okay so I'll pick up my Can I pick up my past blood work now because I didn't yeah and then I'll come back Yeah, even whatever is done today. I can print it out for you Oh, okay cool and the previous so and then I come back to get the other paperwork for the kidney and liver did you say? You can yeah. Because it's not going to be in until later today. Yeah all right. Okay thank you. Excellent. Thank you it was good to see you. All right you take care. Have a good holiday if I don't see you but I'll call you. Merry Christmas. Merry Christmas. Okay I went out here. HPI Gina overall is doing well and has changed her dietary habits and has lost weight period. She has not had any treatments. since February of 2021 and doing well period. Last scans were January of 2023, which were an remarkable period. Plan, colon. Gina is doing well period of this wind coma. I will have her undergo a PET scan in the next three to four weeks and I will call her with the results via telemedicine, otherwise see her back in six months period. She will continue at her better diet and weight period. This is all discussed with her and she wants to understand in period depending on the PET scan. She may need a colonoscopy period paragraph in terms of her pain in the back. Likely it's muscular, we will see what the scan shows, otherwise. you may need a massage and physical therapy period. All questions may be answered. Kamaru Yushin was given counseling with them period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The other comment here was, let me summarize the physical exam. Examination revealed no seemingly edema of the right or extremity. Good mild tinnitus, palpation of the mid-diffle, anterolateral leg, and no sign of both of the ankle plus knee period. He had slight discomfort, lateral in the leg with ankle inversion, come up full range of motion with five out of five motor strength of tibialis anterior and gastroxalus and extensor groups. Gait was moderately ontalgic on the right. Thank you." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hello. Hi. How are you? I'm hanging in there. How are you doing? Pretty good. How are your feet doing? How are the feet doing? Mm-hmm. Well, they swell if I sit at a table and my feet are down. Okay. Have you ever had the veins in your legs tested? Uh, oh, I years ago. They had they did you mean they go along the lake? Yeah, I'm gonna check to see if your yeah your valves are leaking And I lived in then I lived in New York City Mount Sinai They did do they say they had leaky valves? Yeah. Well, they said they said that there was some Numbness in my feet. Mm-hmm. How long have you had diabetes? Probably since I'm... usually just the first day and then the next day. It feels fine. Alrighty, alrighty. Okay, nice to meet you. Thank you so much. You're welcome. DP 104 bilateral PTE trace bilaterally skin temperature, color and texture are all within normal limits. Bilateral pez plantar bug is performing no-tid period. Light touch sensation is intact. And 10 out of 10 positions is beat to foot by since Wednesday, Monday, film on period. Of note patient does have evidence of a record. lesions one in the planar spic to the right hallux in the other on the medial aspect of the left hallux diagnosis diabetes mellitus type 1 and planners works playing patient was given information regarding proper dynamic foot care patients neuro-measure status is stable at this time patients warts were debated today with 15 by that incident they were then treated with cantharidin and placed under occlusion usually left covered and dry for 24 hours she would fall up and approach six weeks to monitor her progress Thank you." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " presents her with continued right foot pain. She has interdigital pain between the third and fourth toe. She has digital deformities in history of prior surgeries on these areas. She does have significant cows buildup on the medial aspect of the fourth toe. She has failed conservative options with padding and wide shoes. She does have the area to breathe it periodically every four to five weeks. Generally, however, she knows this is not adequate and her symptoms are significant. She notes significant pain associated with this. She does inquire about surgical options. Exam two slash border cells, pubic and posterior tibial pulse to the right foot. Right fourth toe demonstrates lateral deviation at the proximal interphalangeal joint with prominence immediately and hyperkeratosis. immediately. There is no ulceration, but there is pre-ulcerative hyperkeratosis. Third toe demonstrates prominence of the proximal phalanx laterally at the area of interdiginal impingement. No ulceration noted. Assessment digital deformities, right foot with interdiginal hyperkeratosis. She has chronic recurrent pain to the right fourth toe and hyperkeratosis that is at risk for ulceration. She has failed conservative options with padding, appropriate shoes and periodic debridement. She inquires about more aggressive options. There are digital reconstructions with fusions that would be available. Also may just consider partial ostectomy slash exostectomy to see if this does reduce interdigital pressure as that is her significant issue. After discussion of options and recovery, we will proceed with in-office partial ostectomy. of the third and fourth toe to see if this does reduce her symptoms to review procedure and recovery course. She will schedule a set of her convenience." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I was just thinking... I was just, hey... She's worried because she's worried that you are gaining weight but he really looks super healthy. You just want to have like a perfect thin Mr. Atlas. Oh you look healthy, you look great. I'm healthy but I just... I need to lose some weight. Me too. I mean I needed to lose weight when I started this thing and I'm already a bit putting on weight. I jumped on the scale of at one point I was up to 228 and before I started it I was... So I don't see you often enough because you are going to San Marcos now and because she has like hyper attention. Everything that happens she knows before all of us and that's why I haven't seen you very often but you know the things are going great, right? Yeah, I'd like to hear from you. It's not a second hand. Yes. So let's start from the beginning. The most important thing is how you feel physically. It's more important than the test or the result. How do you feel physically? Right now, pretty good. Do you have pain anywhere? Yes. Where? I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. I have pain in my back. region where I just had this thing put in for the radiation. So it hurts above your balls. They went in there and yeah. They put these, well you know what they do. Under his balls. I don't think if you had radiation with hoops that was not going to be needed. They do that for proton, they do that for the cyber knife because the technology that we have over there is a little bit better than they don't need to do this but this technology is really good. Yeah he told me this was good the outcome was going to be a little better. that end up putting in the 87% for 10 years or better. So that's what I went with. It's like, I don't care what I have to go through, how uncomfortable it is, just get, I want the best result. And the Darlingson is great. And the technology is the same. They're gonna irradiate the prostate to kill everything in there. What's up with that? They need to separate the nerves and the blood vessels from the prostate with this little procedure, so that they can give you maximum intense radiation to the prostate and the nerve don't feel. it so that you don't have incontinence and if you develop some impotence it happens 10 years from now 15 years from now because slowly slowly it's gonna happen but taken the day by many many years. So let me ask you a question about that so he's gonna get 25 days of regular radiation and then they're gonna give him a break for two weeks and then he's gonna do stopwatch after that. And then you have a consolidation. in forest runs, the patient is there and the machine moves around you lots of degrees, like 360 degrees in many, many axes and many axial directions. And you're lying down there. The technology that he has, the bed moves a little bit and the machine moves around you with more flexibility than the one we have here. And that is very, very, very underhanded. They have a cyber knife, they are competing in. like Mercedes versus BMW. Right. But it's all gonna, he said 87% chance is gonna get out. Yes. Yes. You're gonna be very good. Honestly, in data, all these different machines do exactly the same thing. And of course we went to Linson because he's really very intelligent. He's a great doctor. He will look at you more as a complete thing. We like him. Pretty good judge of character. And when we talked to me, sound like he knew what he was talking about. Yeah, he was training in Harvard. He went to Harvard. Right. Who gets there? Just geniuses. He's very smart. So we have to have the two smart doctors. So we have Dr. Bassetto and Linson. The two smart ones. When I was laying in there a couple days ago, was it yesterday or a couple days ago, that they tattooed me, he came in and he dressed nice too. He's stylish. He's bougie. He's bougie. Always there. So bougie. His wife is like, oh really? Is she pretty? Not really. Kind of. Oh, she's very rich too. She comes from money because she comes from Northern Mexico. She also comes from Mexico. She comes from... Her ranchos and this and that. Her father is my patient. Oh yeah, I heard. I know. Yeah, yeah. So, what I'm going to open now is what you heard before, which is the PET scan, right? And it's really great news. But I'm going to describe it line by line here. You already read it probably. Well, I read it probably. That's the problem. I hear it from two different sets of labs and it gets distorted. I want to hear from you and what's really going on. So, in the neck, there's nothing. In the thorax, it's important because you have lymph nodes and long nodules. And practically, this interval resolution, practically we don't see anything. That means that the chemotherapy to the immunotherapy killed everything. Of course, you're thinking, well, what am I going to get radiation? Because in the prostate, you have different types of cells that do not respond as well to chemotherapy or immunotherapy. So, what am I going to get? radiation. Radiation works. Radiation works everywhere, right? How come we don't do it everywhere? That's the word I'm on right now, right? The... The radiation you're going to get here in the prostate. The... The immunome. The immunome I just took yesterday. That's for the lungs, right? Yes. In the abdomen and pelvis, the only thing we see is the following. The liver relations have interval resolution. In the right departmental lobe, there's a tiny little area that is not... there is nothing. For those resolutions, the people who's not active. So there's nothing, the liver nodules that we worry, when there is cancer, we worry about the lungs and the liver. They are vital organs. And the liver and the lungs, they are nothing. If you're just in the prostate or just in the bone, nothing happens. But let's go to the bone. In the bones, you have diffusely increased optic throughout the bones because chemotherapy does that. Chemotherapy stresses the bone, so all the bone wakes up to make more blood cells. So it has that type of pattern of chemotherapy induced. But that doesn't mean he has meds in his bones. No, you don't have cancer in the bones, but you have the side effects of the cancer. It's like if I make a hole in here and fill it up with cancer, cancer is killed, but in the dry wall, there's still a little hole. And then I'm going to patch it, that's called sclerosis. So I see the sclerosis. You see, you have like reactive bone making new bone, more calcium in the bone, and we call that sclerotic lesion. They're going to be there forever. Even if you are cured, they're going to be there. And there is no cancer metabolic activity. We see the scar, but we don't see cancer metabolic activity. So the conclusion is that you have a very favorable response. A with there's really a resolution of activity in the lung. We have tiny little dots, few millimeters. That is not cancer resolution in the lymph nodes that you have in retroperitoneum, in the medastinum, in the abdomen. Practically we see nothing. The only activity is in the prostate. Let me see the details of what it says in the prostate. The prostate is stable in size. It measures four centimeters. And there is a persistent section of the prostate that measures three centimeters that continues to have metabolic activity. What is metabolic activity? When you do a PET scan, they give you sugar. And the sugar is absorbed by all your body. And whatever we see of this radioactivity in your body, we call it one. one. Anything else is more than one, it can be inflammation. I would like to see it up to maybe two, 2.5. That can be just inflammation, like colitis, like a joint inflammation. Anything more than 2.5, we think is cancer because cancer is dividing, having more calorie activity. In all your body, everything is background activity. In the prostate, there is still level activity 15. So that means that the chemo, I gave you. and the immunotherapy, it didn't make it go away completely. Now we were really, really conservative. I can say that that activity in the prostate is because of the immunotherapy. Because immunotherapy goes where the tumors are, and they cause inflammation and metabolic activity. So for example, imagine that this is your body, and this is cancer, and this is cancer. At the beginning of immunotherapy, we always see more metabolic activity in the tumors. So the prostate, where the cancer was born, we think, It may be the immunotherapy giving you this level 15, because the cancer is not bigger than before. The cancer is not growing, and the prostate looks the same size. It's just that there is a metabolic activity. It may not be cancer. It may be just immune activity fighting that area. Now, why is it still fighting there and not in the lung, not in the lymph nodes, not in the liver? Because this is where you have most of the cancer. All your prostate probably was replaced by cancer, so it's gonna take longer to fix. So if there may be... immunotherapy fighting the cancer, then why do you need radiation? Because the cancer was born in there. The stem cell, the mother blood cell of the cancer is right in the prostate. The cancers that migrated to the lung, to the liver, and somewhere else, there may be, there may be cells that have transformed and they grow faster, but they are not the mother prostate cancer cell. The mother prostate cancer cell may be resistant to chemotherapy. Chemotherapy only fights things that grow fast. Chemotherapy kind of interrupts the vision of a cell in the middle. And the prostate typically grows very slow, and maybe the chemotherapy didn't kill all the cancer there, although it may be in chemotherapy. Number two, radiation works. And you can cure people with radiation. So we cannot trust that immunotherapy is going to work. I'd rather go to radiation and kill everything you have. So this idea of doing radiation maybe was not true. who recommended, I don't know who you talk to, but I completely agree with that. We need to give a radiation there. That will be the standard, right? Well, when we first saw Dr. Hoops, he, you know, of course that's when he had all this stuff going on. Hoops said he wasn't a candidate for radiation, but. At the time. At that time, but. Now, Dr. Hoops is great. He just has a funny personality. The way he looks at you is funny. And you need to. A few things he does is funny. He does a few things that are funny. So this is a picture of your body. So you have some lymph nodes that look like cancer. You have some long nodules. You have some liver nodules. Over here you have the bladder, the urethra. Right here is the prostate. Behind it is the rectum. So when they give you radiation, you're gonna feel pain when you move your bowels. And you're familiar with that. I already have a pain when I move my bowels. This is gonna be the last sacrifice of feeling. uncomfortable, right? Of course you have in this area, you have the spinal bones, right? And then you have your kidneys right there. In that area, which is in the back of your abdomen, you have some lymph nodes with cancer and that's all negative. Cancer from the prostate through the lymphatics went to these lymph nodes that follow to some lymph nodes here and they end in the chest. That's a lymphatic chain. And everything is great except the prostate. spread is killed. I think this prostate cancer, somewhere in there there was a cell that mutated and invaded lungs and liver. And of course this is your vein and your arm, we gave you their chemotherapy, whenever they're everywhere and kill everything. The prostate, which is where the cancer was born, I think there's still cancer in there or maybe just immune. The queen bee, so to speak, right? The queen bee, that's what we're going after. Yeah, that's the exactly where killing, I hate to use the example but Israel is not going to stop bombarding Gaza. They empty this land from the jihadists. The jihadists are the guys that bomb Russia, bomb the US, send whatever, these guys are cancer to humanity. Okay, so. So you're gonna get radiation here, now we're gonna get physical. Radiation is a physical thing. Radiation are X-rays that cross the skin and kill the cells, and it's gonna work. Look, they signed your cup with hearts. Huh? Take that home. Okay. She wrote that? That's Charisse. Look, look, Charisse. Charisse is incredible. Oh, that's nice. Okay, so the way you have to see is that we clean you up from here to here, clean. And we need to do radiation there. Knowing that maybe this is just inflammation and that we were going to cure you anyway, but it's better to do radiation because it's right there at the tip of your body. that radiation is gonna be curable. How come we don't do this type of radiation here, here, and here, and here? Because it damage healthy tissue. Right here, you're at the tip of a cone of this triangular area, but the only thing we're gonna hurt a little bit is your anal canal and the prostate and the urethra, but that's all gonna heal. So when they radiate it, it only kills the cancer? Does it kill my prostate? Well, it's not gonna kill the prostate, the normal prostate cells. Maybe when you're a yucky. that you want to have less fluid as possible. I'm just asking, does it kill tissues as well? So when I start this treatment, this radiation, is it going to start getting inflamed or is it going to start to shrink? It's going to start, but it takes two months to shrink. So if you have right now some hesitancy when you pee or you need to be there and wait 10 minutes for the stream to start, that may improve. Okay. Maybe later we need to go to the urologist to open up the hole. I'm already taking Plo Max now. He talks to him about that procedure of opening up the hole. rottor rotor. You may need to do that. We all are going to need it one day. But he gave him Flomax and it seems to be helping. Flomax, what it does is to relax the bladder and the uterus. So you can have an easier time with that. It's going to kill the cells that cover the surface of your rectum and your anal canal. So you're going to have some pain, but that's going to heal. And yeah, you're going to have some... What I thought was, you know, I know this is all cleaned up, but there's still many of them. Minuscule shit floating around right the little small stuff. I was just wondering do we go back in after Radiation for more chemo just to make sure we kill all the guys find that hiding in the foxholes Or do we wait three months six months down the road and do another pet scan to check it out or Let's talk about that We have cancer in your lungs in your liver in the lymph nodes and we clean you up from there to there So how do we get there? Because we gave you a recipe chemo. How come I call it aggressive? Because the standard is taxotere. Well, no, we didn't give you taxotere. We gave you taxotere plus drug or carboplatin. Now when we did four, you were already clean. Well, guess what? We gave you two more. Not that I made you cleaner. You were already clean. But we gave you two more after complete response. So we already were aggressive. Now chemo, I can keep it to you forever, but why? You may not need it. No, no, I'm asking you, I mean, what is typical? Typical is to do four treatments and then stop. We did six. Yeah. And then on top of that, we gave you immunotherapy. But we didn't give you just guided variety immunotherapy. We only got lucky with your insurance because I just wanted to give you Obdivo. And Xtandi too, I'm on that. Yeah, you're on that, that's something different. I was going to give you Obdivo, but your insurance say, with this chemo. We like you to do Obdivo with Yervoy. I was not planning to be that aggressive, give you double immunotherapy. We gave you double immunotherapy. This one is quite toxic, four cycles of it. Remember you put it in four. And then Obdivo, you're gonna stay on it for two to three years. Obdivo is an immunotherapy that keeps binding anywhere it finds something called PD-1. And when the antibody binds PD-1, the immune system is gonna attack that cells. And you're gonna stay on that for two years. Even if you're right now in COVID-19. They said two or three years. You can say forever, he says two or three years. Well, no more than three years, but forever means long, long time. Okay, a long time, but not forever. I think two years is what we do. If you wanna stay up to three, we can. I don't wanna do anything. But Odevo is gonna be there for two years. Now, this is the thing. If in two years there is no disease, maybe it was that we got so lucky that maybe you are cured because this aggressivity of tumor, back in six months means that we got lucky, right? So we're gonna do two to three years of Rodevo. Let's see how we feel. These are gonna be emotional decisions because I don't have any science that says that two is better than three. I don't have any intelligence data, scientific, to say that three is better than two. But we'll see how we feel. Maybe there are some funny things going on because the bottom line is that the way we took a Petscan is slices of you like this. Every one centimeter will make a slice. of you. Right now we only see cancer here and that's going to be gone. We're going to keep doing this thing every three months. Okay. So every three months we're going to know and there's going to be some noise. Oh there's a little noise in here because if I do a pescan on every city and walk in the street we see things like in your skin right your skin is never stable. Sometimes you have something like this, sometimes it's not. Same thing inside so we're going to see things that we're going to be judging. That may be something that may be not. So we're always going to find something that makes you nervous. Right now we see these, that maybe or maybe not. And that's unavoidable. Every time I do a CAT scan, we're gonna see something that, oh, there's a little nodule there, that maybe something. And you're never in peace. But you, Matt, you know how your body feels, right? You know you're better now than before. Way. You know that you're gaining weight because you are enjoying food. And you are eating and you feel great. So you know your body. Usually patients know before the scan when something is wrong. What if you just feel something is bugging you? your appetite is low, you don't feel that well. We do a CAT scan and we see something, you're not gonna be surprised because you know your body, right? So we did immunotherapy and then comes the traditional hormonal treatment. What that is? Carden varietal prostate cancer. We only block testicles from making testosterone and that will be the lupron injections that you take every three months and that, that I'm gonna keep forever. That one sucks. Or if you want to have more libido and more testosterone, but this is the thing, if we stop the Lupron, you start making testosterone and there's a risk of the cancer coming back. But let's say that it's been five years, five years and there's no cancer, we can stop the Lupron for six months and then go back to it one time and then we stop for two years and then we go back to it so you can have some time of feeling the testosterone. Yeah, thank you. No. Extanded. Extanded prevents the little testosterone that you make in your adrenal glands not to be active. So the combination of these two drugs we call it complete medical castration. It's like you're castrated right now. But we're going to do it for a long time and then you and me come to see me without her. We can negotiate. You say, Dr. Vissar, it's been two years. I want to feel some of that testosterone. And we can negotiate to stop the lupine. We can go to more injections. One month, not three months. One month, not three months. And we keep an eye on these X-rays and also on your PSA. I don't know what you're- I just had to take that the other day. I think it's 0.1. It was 0.1 the last time, then I think they just took it again and it was 0.1. That is fantastic. As long as the PSA is below one, it's great. You'll be proud. I haven't been obsessing in his chart, so I don't even really know the results. All right, let's check them out. So it's been... It's been... Obsessing on it doesn't help. No, it's not a good idea. But you know, at first... But as long as he's happy like this, playing the guitar, gaining weight... Well that's the thing, I haven't been playing any guitars. Why? He's been too tired. It's taken my ambition away, I don't know dude. Is that distortion? You have to force yourself and you'll get back in the swing of it. You know, it's been cold, it's been rainy. know and testosterone is a hormone aggressive guitar your PSA is below 0.1 below 0.1 some measure when we do radiation you're not gonna get PSA for the rest of your life so we're doing great yeah we're doing good You are more worried than him. Okay, so you're gonna stay on this forever, but you and me are gonna negotiate when to give some light. This is gonna be there until we decide to stop this too. And the immunotherapy, which is the best drug, that we're gonna keep from two to three years. Yeah. Right? You're doing great. So what happened is that the very fast growing cells, aggressive cells, we killed them with the chemo, and I don't think they're gonna come. back. The enemy is there in the prostate that's where the cancer was born. Hopefully radiation will kill the last one. So I have a question about the Opdivo. So when his Opdivo expires next year, we have to get a new Opdivo. Are you still going to say that there's lung? So we can keep getting it. In your chart, I always say lung cancer, prostate cancer. What do you think you have? Because I used to have it. I just got my little spots in there. Yeah, you have tiny little nozzles. But it doesn't matter. You may have clean lungs because we gave you chemo immunotherapy. But this is the bottom line, although I think that you have prostate cancer, young man, pulley differentiator, that went everywhere. Maybe you had two cancers. Nobody can prove that this is not lung cancer. No. So maybe you don't have, this is yours, right? We have to go with that. So you have lung cancer, we're going to give you an Ob-Di-Bo forever. Do I want to give you more chemo? No. Why? It's toxic. It's a poison. You don't need it. Do I think you can be cured? I'm not, I think yes. I think yes. And I have patients cured with lung cancer. Right? So what you need to do is be healthy because, as I told Alicia, your enemy is not dying from heart disease. Right? It smells good in here. I'm more afraid of your heart disease than your prostate cancer. So you need to eat healthy, lose some weight, walk, exercise, do some aerobic exercise, keep relationship with the cardiologist, make sure your stents are never closed. He's back on Plavix or anything like that. Yeah, Plavix and baby Austrian. I still got this blown out knee, the hip, and now they just show up to flagpole up my neck. I can't believe it. I can barely sit down. I didn't know that he keeps it in there. I got an exercise bike and I got to use it for two days and then... But it was sore down there. We never see these when we do prostate cancer. We do it with UCSD or with Zika. They don't do the spay out. They separate the nerves from the prostate. to be able to burn the prostate and preserve the growth of the In this cyber knife technology they put a gold seed in the middle of the prostate. He's got two. And the computer follows the goal to resab you there with radiation. He's got two gold seeds. We don't do that because it's a different image in technology. But it's a great technology. He's got two gold seeds. They put the thing about the size of my finger and insert it. Too much inserting. Underneath his balls. They say he had a ratchet on the end of it too. Okay, let's let them get back to work. Alright, let me... having so much fun. Is this your sprite? Can I have your pen? That's mine. Sorry I took it. She took it away." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 29 year old male presenting for follow-up regarding acute right-sided neck pain that began on 8-1-2023. Are you Sterling? Hi, how are you doing? Good, good to meet you. My name is Lindsay. I'm one of the other physician assistants here. It's great to meet you. Let me see if I can start my video. Okay. Um. Alright. So, I was reading through Eugene's note, kind of filling myself in on things. How has everything gone since we saw you about a month ago? Um, pretty good. I definitely would say I have a lot of shoulder pain still, but my neck has been okay. It gets really tight sometimes, but especially when I first wake up. Yeah. Okay. Is there still pain radiating down your arm or numbness? No, not nearly numb as they mixed up. Okay, good. Your MRI looks great. It is a perfectly looking neck. There's no disc bulges, no signs of arthritis, things like that. The neck looks very healthy. And so typically with this, we usually think this is more just muscular strain. Sometimes when those muscles are really inflamed, it can still irritate those. nerves as they're kind of traveling through them so sometimes that can cause some of that nerve irritation feeling as well. So I'm glad you've already had some symptom improvement. Usually our next step for this is usually getting you into physical therapy to just work a lot on stretching and strengthening to try to help prevent this from happening again. Okay. And then with medication are you still taking any sort of anti-inflammatory? No, I didn't take them for very long. Okay. You still probably have some in case you need it. And then let's see, have you been able to set up a PT appointment? I have not. I have the diclofenac. Yep, that's perfect. And so yeah, I would say our next step is definitely getting you into physical therapy. If the numbness or tingling continues to get worse, you can always get an EMG study. of the arm to see if that nerve is entrapped. That's typically used to find like carpal tunnel. Again, I think this is probably all just from muscular irritation, but I know you've had kind of a history of that. So if this gets worse again, maybe that would be another test to do down the road. Okay, great. And then yeah, one other thing- I did get told I had a slight impingement in my shoulder by him. Okay, yeah. Previously. Yep, yep. And then one- One other thing in your MRI report, it notes that there's a very, very tiny nodule on your thyroid gland that's nonspecific. People will just have these benign nodules on their thyroid. I do not evaluate for this, so I would just recommend like taking this MRI to your primary care doctor and seeing if they want to refer you to anyone, but I have a feeling there's nothing to do about that. Okay. And then that is kind of all from my point. Any questions for me? No, that would be great. Do you send like a PT overview to me that I can bring to a PT? So, I'll send you the list. It looks like Eugene sent it last time, but I'll send it again. It kind of prompts you to find a place, make an appointment, let us know where you're going to go and I'll fax them a referral. Okay. So, yeah, I'll send everything that way and then I can also send you some next kind of baseline stretches as well. We have a little printout as well as our shoulder impingement. Okay. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. guide and then you'll also get a copy of your MRI report emailed to you when I lock your note later today. Okay fantastic. And then I would say probably let's check in in a like two to three months and see how you're doing. Okay fantastic well thank you so much for the help. Of course it was good to meet you I'm glad things are improving and hopefully they continue to. Alright thank you so much. Alright take care. Okay bye. Bye. general PT referral for neck muscular strain. MRI was done which rules out any disc herniation or cervical pathology. He's gonna follow up in two to three months no x-ray needed." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is telemedicine visit, Laura period. Laura underwent dototate gallium PET scan, which was performed February 5th, 2024, which was compared to a year ago scan, February of 2023 period, and one year come out, things have not changed as the avid lesion of the distal alien is stable, concerning for primary small bowel neuron to consume her with a stable dototate avid hepatic metastasis as well as right mesenteric node, as well as intra-thread. which are non-specific and loculated right pleural fusion which is moderate and compressive atelectasis, all stable compared to a year ago period. She has been getting linneotides and so far has had seven doses of injections as well as getting retro-crit injection with a stable hemoglobin period. HPA Laura is generally doing okay with the exception of some fatigue where she's getting linneotides every four weeks as well as retro-crit period. Glen Colen Laura does not have any progression or improvement compared to a year ago PET scan. as everything remains stable period. In this situation, I will continue with the linioetine injection as well as reticrate as needed period. Paragraph, she's having some shoulder pain on the left side. Since the surgery, it could have been with position change from one place to the other at the time of surgery period. I would like to obtain plain x-rays as well as MR of the left shoulder to rule out rotator cuff tear or any other fracture. Otherwise, she may need physical therapy or localized injection to help the pain period. This was all discussed with her and she voiced understanding period. All questions and answers, pre-assurance was given in counseling with Ben Fierro. Paragraph time has been 35 minutes." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The patient presents for follow-up of a third metatarsal fracture following a motorcycle accident on 10-19-23 period. The patient reports that he still has pain along the dorsal aspect of his foot, coming by his notice of gradual reductions since he was last seen in clinic period. The patient does note that since he was last seen, he also has started to develop pain along his leg. thumb area as well exacerbated when he utilizes his phone. Period. Please copy over right wrist and hand exam with positive tenderness to palpation over the snuff box and positive Finkelsteins. Also copy over prior right foot physical exam for right foot x-ray series. Please insert oblique third metatarsal fracture with maintained 5.6 millimeters of shortening similar to prior imaging taken in clinic period. Also please insert a right wrist x-ray series with benign findings. For assessment plan, patient presents for a follow-up of right foot pain following a motorcycle accident on 10-19-23 period. The patient was diagnosed with a third metatarsal fracture. with 5.6 millimeters of shortening period. Updated x-ray imaging completed in clinic today does not demonstrate any additional shortening or displacement in comparison to prior imaging. As discussed with Dr. Dickinson at the patient's prior appointment, the patient can continue with non-operative treatment period. Updated x-ray imaging of the patient's wrist to evaluate the scaphoid was also completed in clinic today and does not... and not demonstrate any concerning findings, period. Discuss with the patient that I believe he's dealing with dekervin's tendicitivitis, that there is, and we'll send him education on this today, period. He will return for follow-up in four weeks to evaluate the status of his third metatarsal fracture, period. Follow-up, four weeks, radiology, x-ray, foot, three views. Please send education on dekervin's tendicitivitis, period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " HBI, dear Dr. Shabafroze, S-H-A-B-A-F-R-O-O-Z, colon paragraph I saw, Ms. Manzano today, from the Office for Hematological Constellation, peer heard. history is well known to you but I'll take this time to do it for the completeness of my record spare paragraph. Ms. Manzano is a pleasant 37 year old lady who has been in fair health most of her life period. She has been noted to have slightly elevated plated count as the CBC performed previously has not been given to us yet but it appears on the chart that that was the reason for consultation period. Farriton was noted to be 73 performed November 6, 2023 period. The iron panel is essentially a remarkable period. WBC then today reveal the WBC to be 12.4 hemoglobin 12.5 hematica 39.2 mCv 95.1 platelet count 481 period. Paragraph. Hello, Ms. Manzano and Dr. Haseem, nice to meet you. Sorry to keep you waiting. Seeing you for the first time, so bear with me, I'll be asking some questions that may have been asked before. Okay. So there's no reason for you to be here written, but I suspect it is because you're platelets being high, is that what you're told? Okay. Okay. Uh, and you were told recently about that? Mm, no, I've actually known for a while and I was getting treated and then I stopped getting treated and I thought I was fine and then I started getting treated for it again. What do you mean treated? Well, they had told me about it, um, back in like 2011 and I was going in getting checked. They were supposed to do like a, um, a spinal where they do like a check to see if it maybe was like leukemia or something, but They ended up not doing that simply because my insurance canceled out and then when I went back to the doctor They didn't tell me anything else about it. So I figured I was fine. So you have seen a hematologist like me I have seen a blood specialist before when I'm in Fresno Kaiser. Yes Oh Kaiser. Okay. Yes Then did they tell you that you have ET are you familiar with the term ET essential thrombocytemia? Okay, so But do you know the number the platelets how high they were? Okay Alright, so usually the most common cause of slightly elevated platelets, which you have slightly elevated platelet count, is low iron. How's your period? Is it heavy? No, I think it's mostly... I don't really remember how long, but it's just been like spotting and it only lasts like two days. Any rectal bleeding, blood in the urine? Yeah, no blood in the urine, but I actually did have a little episode this weekend where I bled in my stool, which has... happened a little bit lately. You had hemorrhoids or anything? Never been told I've had hemorrhoids. Well, I mean, have you felt hemorrhoids? No. Okay, and what about constipation? Do you have constipation? Yeah, every now and again. Okay, all right, no black stools? No. Okay, all right, and have you supplemented with iron? I think I did for a little bit, right after I had my bariatric surgery. Oh, okay, so you had bariatric surgery, I forgot about that. Okay. When was that? I had bariatric surgery June 10th of 2020, what are we 24, 22. Me too, okay. So and who did the surgery? Dr. Haga. And did he say that hey in four or five years your iron and vitamins will drop down and they'll go low? Not really. Okay. They didn't tell me a lot of things I just had the surgery and okay now I'm finding out all these things. So with that surgery normally when we eat from the food the iron and vitamins get absorbed from the... in the lining of the stomach and first part of small intestine, but when you do the bypass in those lining, they're not available to absorb it. So after four or five years when the stores are wiped out, everybody gets low in iron and vitamins. So you're not quite there yet, but your iron may be low. I'm checking it to see. And that could be the cause of platelets being high. But since you've had history of having high platelets, I may have to do a special test to confirm whether you have ET, which is a bone marrow process. 50% of the time the test is positive, but 50%... of the time it is negative. But as long as the platelets are under 500,000 is really not a concern. The concern is that if they go too high, blood could be thickened and the person would be at risk for clotting, heart attack or stroke. But your 481 normal is up to 450. So it's not very high. And the problem doesn't happen until they go above 100 or not 100, 1000 I should say, or which is a million. 481 means 481,000. That's what I mean. So 1000 means a million, basically. So you're. not definitely that high, but I will just in case do the testing for that. Let me see. It takes about two weeks for these results to come back and I can call you with the results and see if there is anything there that may be contributing to it. But the iron and vitamins when they come back. if they're low then we'll have to see if we need to give you iron as you may not absorb as much by mouth and then do you supplement with vitamin b12 or d? I have vitamin d. I do take vitamin d on a weekly basis. The higher dose of 50,000 or? Let me see. I have it right here. I have it right here 50,000 yeah so that's that's the right dose and but no b12? No. Okay any family history for cancer in the family? My grandma had it but that was long ago. Mom's side, dad's side? Mom's side. And what type of cancer? Mmm... I'm not sure. That's okay. You don't smoke or drink? Otherwise, never been pregnant? No. Okay, alright. And... okay. Come up here. So when you had the pancreatitis, you mentioned the history. Was it because of the... That's what they're checking. So I do have gallstones and they're doing my current doctor's doing all the testing for that right now And who do you live with Currently I live with my ex-portrait. Okay. Were you married before? I was a long time ago Deep breaths, you know Then we lie down. Then what kind of work can be done? Are you doing? I am an accountant. Put your arms down here. There you go. Sorry. Tender. Take a deep breath. Out. Again. out I the seat me S So I don't... suspect anything bad or terrible in the blood to be thinking of bone marrow, but your platelet count's slightly elevated, white count's slightly elevated, so we'll do the special testing, and I'll call you in two weeks with the results if there's anything, we don't, even if it's positive, we don't have to do anything right now. We just have to watch it if they go up too high, then I give you a pill to control the platelets. But right now, they're not that high. If the test is negative, and the platelets in. in three months, six months go very high, only then we do the bone marrow biopsy, otherwise we'll just continue to watch it. Okay. Okay, so, but nothing of that concern at this time, but I'll call you in two weeks. Okay. All right. Sounds good. Nice to meet you. Thank you so much. Come out here. They'll help you on the left. Thank you. Thank you. Impression number one. Thrombocytosis, mild, likely reactive, rule out. Essential thrombocythemia, period next to number two, leukocytosis, mild, as above, period. Could be part of chronic myeloproliferage disorder as we will try to rule that out, period. Next to number three, obesity. Period. Next to number four, status with bariatric status with gastric bypass surgery in 2022, period. Next line, plan discussion call. Ms. Manzano is a pleasant 37-year-old lady whose status was gastric bypass surgery, period. Her plate was slightly elevated. and Y-silicon is slightly elevated period. She does have a history of thrombocytosis period. It is possible that she may have essential thrombocytemia come out and not have any results as it was done at Kaiser period. I will try to reject to mutation and CALR mutation at erythropoietin level also period. I will call her with the results in two weeks if indeed they are positive. We will have to continue to monitor and watch and that will not require any treatment period. If indeed the testing is negative and the platelet count remains under 500,000, we will not interject but certainly if they go up too high, we may have to do a bone marrow but at this point I'm not keen on doing that period. I will paragraph in terms of bariatric procedure, come I will be checking the iron profile as well as vitamin D level and B12 period. I will be calling her with these results in two weeks period otherwise we'll check her counts in three months period paragraph. Above all we'll discuss with her and she voiced understanding period. All question and answer, re-assurance was given in counseling within period paragraph. I would like to thank Dr. Sheva Froese for giving me the opportunity to participate in the care of this pleasant lady period. I will keep you abreast of her progress period. Paragraph one, Mr. Garst's copy to Dr. Sheva Froese." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Review of MRI from 7-20-23 of the right calcaneus notes. Planar fasciitis with mild nodular planar fibromatosis." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The patient is a 40-year-old female who presents a clinic for initial complaint of acute right knee pain and swelling that started atraematically on 5-4-24 period. The patient reports that she went for a three-hour long bike ride and did not have any pain or issue during this ride period. However, come immediately following completion, she started to develop diffuse right knee pain and swelling period. She reports that the swelling has been getting progressively worse and pain has been gradually increasing over the past few days period. It is noted that the patient used to be a... professional bike rider and has never had right knee injury or pain in the past period. Please insert a right knee physical exam with 2 plus fusion, positive lateral and medial McMurray's. Please insert a 3-view right knee x-ray series with normal findings. For assessment plan, patient is a 40 year old female who presents a clinic for initial complaint of acute right knee pain and swelling that started out in the past. after a bike ride four days ago in 5-4-24 period. The patient has significant effusion visualized on exam today and significant limitations in range of motion due to pain period. At this time, I'm concerned for potential internal derangement within the knee, such as a meniscal tear or potential OCD lesion leading to discomfort and a traumatic pain and swelling period. An aspiration was performed in clinic today without issue period. MRI imaging will also be sent period. The patient will return for valve after completion of MRI imaging. please send an order to Urgently Ortho MRI for MRI right knee without contrast period. Please evaluate for meniscal injury versus other internal derangement. Please insert aspiration procedure with 75 cc's of yellow fluid aspirated." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type