[doctor] good morning rebecca , nice to see you .
[patient] nice to see you too .
[doctor] so , my nurse told you a little bit about dax , now i'm wondering if i can tell dax a little bit about you .
[patient] go for it .
[doctor] okay , so rebecca is a 27-year-old female patient . um , you have a history of carpal tunnel , um , uh , release done couple of years ago , you have some chronic back pain , some depression . why am i seeing you today ?
[patient] so last week , um , and over the course of the month , i have taken up swimming more regularly .
[doctor] okay .
[patient] i've been trying to get up and get active . and i've- ... all of a sudden i've been feeling some really bad , um , knee pain-
[doctor] okay .
[patient] . in my right knee .
[doctor] just in your right knee ?
[patient] yeah .
[doctor] okay . just when swimming ? are you swimming freestyle with your legs kicking straight or more like breaststroke where your legs kick out ?
[patient] yeah , it's only while swimming. i use the breaststroke so i guess where the legs are kicking out like a frog ... it kinda starts hurting a little bit after i swim a couple laps , which a month ago when i started i was able to do ten .
[doctor] okay .
[patient] but after a couple of laps it starts to hurt .
[doctor] and no injury ? like you did n't fall or twist it or anything like that that you remember ?
[patient] no , not that i can remember .
[doctor] okay . so just swimming a lot and you feeling more and more discomfort ?
[patient] yeah .
[doctor] okay , good . so , um ... i know my nurse did a review of systems before you came in . there were really no significant issues . you have a history of chronic back pain , that's been doing well ?
[patient] yeah , it comes and goes , but right now it's been doing really well .
[doctor] okay , no pain going down your legs or anything like that ?
[patient] no .
[doctor] okay . and i know you have some depression , you've been on medication . how's that been going ?
[patient] that's been going really well .
[doctor] okay .
[patient] with the medication and therapy and then trying to get outside more it's been really helping me .
[doctor] sleeping well ?
[patient] yeah .
[doctor] eating well ? okay . do n't feel any concerns about hurting yourself or others or anything like that ?
[patient] no .
[doctor] okay , good . um , and the , you had ca- carpal tunnel done a few years ago . how's that doing ?
[patient] that's doing-
[doctor] any flare up with that ?
[patient] . that's doing really well . i've been getting full range of motion and it's felt a lot better .
[doctor] okay , great . do you mind if i do a quick exam ?
[patient] yeah , go for it .
[doctor] squeeze my fingers for me . good . okay . is it painful if i move your patella like that ?
[patient] yeah , that hurts .
[doctor] okay . and i'm gon na hold your leg out , i'm gon na hold , i want you to stiffen your upper ... does that hurt when i do that ?
[patient] yeah , that hurts too .
[doctor] okay , good , all right . um , let's take a quick look at your x-ray , okay ?
[patient] okay .
[doctor] hey dragon , show me the right knee x-ray . okay , so here's a picture of your right knee . actually normal x-ray , everything looks good , okay ? on my exam , um , you do n't really have any swelling in- in your joints , um , uh , of your knee . you have a little pain with , um , uh , range of motion of the knee . you have real pain when we do what we call patella in- ... patellar inhibition , okay ? so that's what caused most of that pain . so , um , your heart is regular , your lungs are clear , i do n't feel any adenopathy , your thyroid's , um , normal , your grips are equal , the rest of your exam is essentially normal , okay ? so my assessment is , you have what we call chondromalacia of the patella , okay ? it's just from the overuse and all- all the swimming you've been doing , okay ? so , um , to treat that we'll just use some anti-inflammatories , um , go ahead and take some ibuprofen , 600 milligrams four times a day with food . i do want you to do some straight leg raising exercises , that'll strengthen your quadriceps and that'll help with that pain , okay ?
[patient] okay .
[doctor] um , basically you want to avoid anything that puts extra pressure on your knees for a little while and it should be fine . if it's not getting any better in a couple weeks i wan na see you again , okay ? so no lunges , avoid the breaststroke . if you're comfortable, you can also do other swimming strokes where your knees are straight instead . or you can take the opportunity to have a little break .
[patient] all right .
[doctor] your second problem is your chronic back pain , that's been doing really well . um , keep swimming , that's okay after this gets better .
[patient] yeah .
[doctor] um , but i think , um , i think that's been under control . but if it flares up go ahead and , uh , give me a call , okay ?
[patient] mm-hmm .
[doctor] um , your third problem is your depression . that's been stable . we're gon na keep you on your current medication , not gon na change anything at this point , okay ? and as far as your carpal tunnel goes , that's relatively stable , so , um , uh , no changes there as well . okay ? so anything else i can do for you ?
[patient] no , that's it .
[doctor] okay , well we'll get you checked out .
[patient] all right .
[doctor] hey dragon , finalize the report .


Medical orders:
description: ibuprofen 600 milligrams four times a day with food
order_type: medication
reason: chondromalacia of the patella