Doctor: Okay I am looking at you for multiple issues today. One of the biggest being swelling on your left leg. Can you tell me more about that?
Patient: Yes sure. I got this swelling for almost three years now, and it has been worse for the past two to three months. Sometimes it gets better in the morning when I get up, but then throughout the day it begins to swell again.  Lately it is staying bigger, and it feel uncomfortable with it being so large.  The right leg also swells, but not nearly like the left leg.
Doctor: How old are you, miss?
Patient: I am forty four. My biggest problem is this pain in my left shoulder. I feel as if this low back pain is due to a poor mattress. 
Doctor: Did you hurt your shoulder?
Patient: No, I don't remember hurting shoulder, but gradually I am losing some mobility.  It is hard for me to get my hands behind my back or behind my head.  I am losing strength in the left shoulder gradually for the last year.
Doctor: Ok let's look at your labs.
Patient: So far white counts are high. In April two thousand five Doctor X Y Z was asked to look at my high white count, but she thought it wasn't a problem and asked me to come for follow up.
Doctor: Any other complaints?
Patient: I have a lot of frequency with urination, and I get up to pee at night at least two to three times.   Also, I have gained weight, I think about twelve pounds since March.  Right now, I am two eighty four pounds.
Doctor: Okay. So, I can see that your blood pressure is staying stable.  You do take Atenolol twelve point five M G per day and Lasix as needed. 
Patient: Yes, that's correct. It makes me pee so much. I do not take it.
Doctor: How about chest pain or shortness of breath?
Patient: No chest pain, but I am gradually feeling short of breath.
Doctor: What work you do?
Patient: I work for the city of Wichita as bus dispatcher. My work demands sitting a lot, and just really does not move around much.  But towards the end of the day my leg swells up.
Doctor: Okay that's okay.
Patient: I need cholesterol check right?
Doctor: Yes, you do, but all the other labs are normal.

Clinical note:
Symptoms: Swelling in the left leg, swelling in the right leg to a lesser extent, pain and loss of mobility in the left shoulder, low back pain, increased frequency of urination, nocturia, weight gain, shortness of breath.
Diagnosis: Elevated white count, leukocytosis.
History of Patient: The patient, a 44-year-old white female, presents with swelling in her left leg for the past three years, worsening over the past two to three months. The swelling improves in the morning but worsens throughout the day, causing discomfort. Her right leg also swells, though not as severely. She also complains of pain and decreased mobility in her left shoulder, with associated low back pain. She denies any history of shoulder injury but has experienced gradual loss of strength and mobility over the past year. She reports increased frequency of urination and nocturia, along with weight gain of approximately 12 pounds since March, currently weighing 284 pounds. She notes stable blood pressure, takes Atenolol 12.5 mg daily, and Lasix as needed but dislikes it due to increased urination. She denies chest pain but reports gradually increasing shortness of breath. She works as a bus dispatcher for the city of Wichita, involving prolonged sitting, which exacerbates leg swelling towards the end of the day. Laboratory findings show an elevated white count, with previous consultations regarding leukocytosis deemed non-problematic. The patient requests a cholesterol check.
Plan of Action: Further evaluation and management of leg swelling, left shoulder pain, leukocytosis, increased urinary frequency, and weight gain. Cholesterol check warranted.