Dialogue:
Doctor: Hi there! I am Doctor Jones, sir. 
Patient: Hello! It is nice to meet you. 
Doctor: What brings you into see me today? 
Patient: I have had this weakness in my right leg for quite some time now.
Doctor: How long has this been going on and do you know how you injured yourself?
Patient: I think that it was about six months ago that the weakness in my leg started. I don't really remember how it happened. 
Doctor: Can you tell me what you do remember? 
Patient: I was reaching to get something from a cabinet, and I noticed that I was unable to stand on my right toe. Ever since then I have had difficulty pushing off when walking.  My toes were tingling and numb.
Doctor: Was the numbness and tingling mild, moderate, or severe? 
Patient: It was a mild feeling, but this has been an ongoing problem that has been the same since the weakness started. 
Doctor: Have you had any other pain any where else in your body? 
Patient: I have had back pain, but this has been going on for many years and has not changed.  
Doctor: Is the back pain been mild, moderate, or severe? 
Patient: I would say mild. I have also been having cramping in both calves. 
Doctor: How long has that been going on? 
Patient: For the past year but it stopped about two months ago.  
Doctor: Have you had any weakness in the left leg? 
Patient: No. I don't think so. 
Doctor: Have you had any pain around right leg and the area of numbness and tingling? 
Patient: No. Everything that is going on with my right leg has pretty much been the same since it started six months ago. I have not gotten worse or better. 
Doctor: Have you had any bowel or bladder incontinence? Any radicular pain?
Patient: No.
Doctor: When did you first see a doctor for the issue? I remember that you told me you saw a different provider prior to coming to see me.
Patient:  I saw the other doctor in October. That was a couple of months before I came to see you. 
Doctor: I see in your chart that we did a CT scan that shows degenerative changes, but nothing obviously abnormal. Remind me why we did not do a MRI of your spine? 
Patient: I cannot have an MRI because of my ear implant.  
Doctor: That is unfortunate. It looks like we were able to do an EMG and nerve conduction studies. What medications are you taking currently? 
Patient: I had an elevated CK before I started taking stat medications.
Doctor: What medications are those? 
Patient: I am not taking Lipitor anymore. I think I took it for about fifteen months. 
Doctor: Do you know what your levels of your CK were before you started taking medication? 
Patient: I thought that my CK was in the five hundred or six hundreds prior to starting it. Once I started it, my levels increased to about eight hundred and then came down to about five hundred again when it was stopped. I recently stopped taking Lipitor because my levels were up to the thousand's and then my CK apparently has returned to about the five hundreds or six hundreds.  
Doctor: I don't see any labs in your chart. Did your primary do labs for your CK levels? 
Patient: Yes, he did. 
Doctor: Okay. Have you started any other medications? 
Patient: Yes, I just started Zetia.
Doctor: Have you experienced any weakness or pain after starting Zetia? 
Patient: No.
Doctor: Can you remind me how old you are?
Patient: I am fifty-five.

Clinical note section (GENHX):
The patient is a 55-year-old gentleman who presents for further evaluation of right leg weakness.  He has difficulty recollecting the exact details and chronology of his problem.  To the best of his recollection, he thinks that about six months ago he developed weakness of his right leg.  He describes that he is reaching to get something from a cabinet and he noticed that he was unable to stand on his right toe.  Since that time, he has had difficulty pushing off when he walks.  He has mild tingling and numbness in his toes, but this has been a chronic problem and nothing new since he has developed the weakness.  He has chronic mild back pain, but this has been persistent for many years and has not changed.  He has experienced cramps in both calves for the past year.  This dissipated about two months ago.  He does not think that his left leg is weak.  He does not have any bowel or bladder incontinence.  There is no radicular pain.  He does not think that the problem is progressive, meaning that the weakness that he perceives in his right leg is no different than when it was six months ago. He first sought medical attention for this problem in October.  He then saw you a couple of months later.  He has undergone an EMG and nerve conduction studies.  Unfortunately, he cannot undergo an MRI of his spine because he has an ear implant.  He has had a CT scan that shows degenerative changes, but nothing obviously abnormal. In addition, the patient has hyperCKemia.  He tells me that he has had an elevated CK prior to starting taking stat medications, although this is not entirely clear to me.  He thinks that he is not taking Lipitor for about 15 months and thought that his CK was in the 500 or 600s prior to starting it.  Once it was started, it increased to about 800 and then came down to about 500 when it was stopped.  He then had a recent bump again up to the 1000 and since Lipitor has been stopped, his CK apparently has returned to about the 500 or 600s.  I do no have any laboratory data to support these statements by the patient, but he seems to be up to speed on this.  More recently, he has been started taking Zetia. He does not have any proximal weakness.  He denies any myalgias.