[doctor] hi , carolyn . how are you ?
[patient] good . how are you ?
[doctor] i'm good . you're ready to get started ?
[patient] yes , i am .
[doctor] so carolyn is a 49-year-old female here for follow-up of her chronic problems . so , how are you doing , carolyn ?
[patient] i'm doing okay . um , my osteoarthritis has been flaring up a little bit lately , um , so i wan na get- talk about that primarily . so , it's mostly in um , my elbows and it's really been bothering me . i've been sitting at the computer , at the desk more , um , in the office so i do n't know if it's being stagnant in that position all day has um , increased flare-ups for that , but i wanted to talk to you about that .
[doctor] okay , sure . and , are you right or left-handed ?
[patient] i'm right-handed .
[doctor] okay , and does one elbow bother you more than the other ?
[patient] my right elbow does bother me more than the other , but primarily , i'm typing all day versus writing , so it- it flares up in both .
[doctor] okay . all right , and um , any other joint pain ?
[patient] no , just- just really focused on my elbows .
[doctor] okay , and any numbing or tingling in your hands ?
[patient] uh , sometimes . when i'm typing for long periods of time , i feel a little bit of numbing , um , i try to shake out my arms a little bit . um , just to kind of relieve that um , sensation .
[doctor] okay . all right , and i know that you've had this also , had this history of gout . and the last episode you had was about three months ago . you had some inflammation of your toe . have you had any other issues with that ?
[patient] no , i have n't . um , the medication you gave me really controlled it , and i have n't seen a flare-up since .
[doctor] okay . all right , and how are you doing with your psoriasis ?
[patient] that's been under control too . that has n't been a- a major problem for me either .
[doctor] okay . i- i know that we had given you some clobetasol for your scalp . is that- so that's doing okay ?
[patient] yeah , that's doing a lot better .
[doctor] okay , great . um , all right , well , i'd like to go ahead and do a physical exam on you .
[patient] okay .
[doctor] let's first look at your vital signs . hey , dragon , show me the vital signs . great , so everything looks good from that perspective . um , so looking at you , i do n't appreciate any cervical lymphadenopathy . your heart is a nice regular rate and rhythm , and your lungs sound really clear . on your right elbow , you do have some edema and inflammation of your right olecranon and there's some tenderness and an effusion right there . so um , does that hurt when i press it ?
[patient] yeah , that does hurt .
[doctor] okay , and when i turn your arm , do you have pain ?
[patient] yeah , that hurts a bit too .
[doctor] okay , so she has pain- to palpation of the olecranon bursa and pain with pronation and supination . and when you flex- and when you bend it and straighten it , does that hurt ?
[patient] yeah , it does and it's a bit stiff too .
[doctor] okay , so pain with flexion and extension of the right arm . uh , your abdomen is nice and soft , and there's no lower extremity edema . uh , let's go ahead and take a look at some of your labs . you know , you have a lot of arthritis for someone so young , so we had sent off that autoimmune panel . hey , dragon . show me the autoimmune labs . hey , dragon . show me the autoimmune profile . hey , dragon . show me the esr . okay , so that's good . hey , dragon . show me the uric acid . okay . all right , well , good . that's great . so , you know , it does n't look like you have any systemic arthritis , or sys- systemic inflammatory in process going on . so , my impression of you at this time is that from a gout standpoint , everything is nice and stable . i think that we should continue you on the colchicine 0.6 milligrams twice a day as needed for flare-ups of your gout . um , and then for your osteoarthritis , i'd like to go ahead and order a right elbow x-ray . hey , dragon . order a right elbow x-ray , and then i'd like to prescribe some meloxicam 15 milligrams once a day for the pain and the swelling .
[patient] okay .
[doctor] hey , dragon . order meloxicam 15 milligrams once a day . and then i'd like to um , just see those- how- the x-ray show- shows up and the results of that before we refer you for any type of physical therapy , okay ?
[patient] okay .
[doctor] and then from a psoriasis standpoint , i think everything is stable . we'll continue you on the steroid cream for your scalp , okay ?
[patient] that sounds good .
[doctor] all right , do you have any questions ?
[patient] no , that's it .
[doctor] all right , take care .
[patient] thank you .
[doctor] hey , dragon . finalize the note .


Medical orders:
description: right elbow x-ray x-ray
order_type: imaging
reason: right elbow osteoarthritis
description: meloxicam 15 milligram once a day
order_type: medication
reason: right elbow pain swelling