[doctor] donna torres , date of birth , 08/01/1980 .
[doctor] hi donna ! how are you ?
[patient] i'm good . how about you ?
[doctor] i'm doing well , thank you . and so , i saw that dr. brown put you on buspar . have you been on that before ?
[patient] no , that's new .
[doctor] okay . how is it working for you ?
[patient] my anxiety is going good now , thankfully . i'm serious , it was brutal in november and december . finally , i was like , " i can not do this . " i have no idea why it happened . dr. ward did put me on singulair , and she did say we need to be careful because singulair can cause anxiety . so i'm not sure if that was the issue or what .
[doctor] mm . okay .
[patient] and it would , um , start usually during the day , at work .
[doctor] i see .
[patient] i mean , i'm fine now .
[doctor] well , that's good , that things have settled . i do wonder if some of what you are dealing with is hormonal , and that's why i was asking . 'cause you were on the progesterone , and i feel like you were having some irritability back then too .
[patient] i did .
[doctor] and that was before we started the progesterone .
[patient] yes .
[doctor] so i know we started it for regulating your periods , but perhaps it helped with this also .
[patient] yeah . and before , in november and december , i noticed that the week before my period , my anxiety would go through the roof . which then , i knew my period was coming . then it turned into my anxiety spiking just at random times .
[doctor] hmm , okay .
[patient] and it seemed like it was for no reason .
[doctor] but november and december you were on the progesterone at that time .
[patient] yes .
[doctor] all right . so not really a link there , all right .
[patient] yeah , i do n't know .
[doctor] yeah , i do n't know either . um , sometimes with the aging process , that can happen too .
[patient] i figured maybe that's what it was .
[doctor] and we did go through the golive in november and december , so that can be pretty stressful also .
[patient] yeah , and at work , that's when i first started to lead the process of delivering the results to patients with covid . in the beginning of the whole pandemic , patients would have to wait nine days before they'd get their results . and then we opened the evaluation centers and the covid clinic . so i think it just took a toll on me .
[doctor] yeah , i can absolutely see that .
[patient] yeah , and then i was feeling selfish because i was n't even on the front lines . i mean , i was supporting people , sure , but i was n't in the icu . so i felt selfish and guilty . i mean , hands down , the physicians and nurses were in the thick of it and there i was , having anxiety . and it felt ridiculous .
[doctor] well , honestly , you feel how you feel and what you were doing was n't easy as well , so ... but let's see . i need to just put this dax back to work . all right , so no other issues whatsoever ?
[patient] no .
[doctor] have you lost weight ?
[patient] no , but i stopped taking the camila birth control . my hunger level was at a new high . i mean , i was eating constantly . i felt like , " what is going on ? "
[doctor] all right .
[patient] and now i am feeling better .
[doctor] okay , that's good . and your masked face , though , it does look thinner .
[patient] well , the past six months i have lost some weight .
[doctor] okay , good . um , anything else going on ?
[patient] no .
[doctor] all right . so your pap was in 2019 . i do n't think that we need to repeat that because it was negative/negative . um , have you ever had an abnormal pap ?
[patient] not with you , but i did around 2009 , and then i had to be seen every six months for a while . and then i had a normal pap .
[doctor] all right , well , let's just repeat it then .
[patient] yeah , that's fine with me , to be safe .
[doctor] okay . i know it sounds superstitious , but i feel like with all the immunocompromising , the pressure , the stress that people's bodies have been under , and the potential for getting covid or the vaccine ... i have actually seen some , um , an increase in abnormal paps in people who have been fine for a while . so that's why i figure let's just check .
[patient] okay . i fight the vaccine fight every day at home because my husband is n't ready to get it . same with my daughter . she shares the same worries as her dad in how it'll impact her when she gets older .
[doctor] have you had the vaccine ?
[patient] yes , i have . and so has my son . he , um , has had his first already .
[doctor] okay . well , you know , you can only do what you can do .
[patient] yeah , i agree .
[doctor] all right . well , let's complete your exam .
[patient] all right .
[doctor] so let's take a deep breath . and again . all right , you can breathe normally . all right , and take one more deep breath . okay , now i'm gon na touch your neck . go ahead and swallow . perfect . and just place your hand above your head . okay , i do feel some little bumps .
[patient] yeah , but they're not as big as they were .
[doctor] mm-hmm . okay , in this breast it does feel a little bit denser . does it hurt at all ?
[patient] it does , where your left hand just was .
[doctor] okay , right here ?
[patient] yeah , down here . but whenever i breastfed , it was always sore there too . i had a clog and something else . the lumps do feel smaller , but they are still there , unfortunately .
[doctor] yeah , they are . uh , well now i do n't know , because if it was the progesterone , they would've gone away .
[patient] yeah .
[doctor] all right , well just let your knees just op- relax and open . how's the itching or discomfort ? are you still using the cream ?
[patient] yes , and i actually need to get that refilled for the first time ever .
[doctor] okay .
[patient] uh , but yeah , i use it once a week and it does help .
[doctor] okay , great . all right , looks good .
[patient] good .
[doctor] you can go ahead and sit up .
[patient] thank you .
[doctor] all right , so typically the lumps would often just shrink up pretty quickly after you've had one or two cycles , and you've had two cycles so far . so i think let's just keep monitoring them for now .
[patient] okay . and what could that mean ?
[doctor] well , so just like people have an increased risk of breast cancer , there's also an increased risk for breast issues . you know what i mean ? so for example , cysts and lumps and fibroadenomas , those are all benign things . they're annoying and require some workup , but they're all benign .
[patient] and i'm- i'm just worried because i'm almost 40 and my mom was almost 45 when she was diagnosed with breast cancer . so i mean , i know there's nothing i can do about it , but it's just i feel like , uh , we had it under control and now it is n't .
[doctor] well , i would n't say that . i mean , i feel like we're at a point where we have a good cadence for you having surveillance on things , and i think you are more aware of your breasts than ever before , and things actually have n't changed .
[patient] yeah .
[doctor] so those are all good things .
[patient] okay .
[doctor] because , um , if it was cancer , we'd actually , we would see some change .
[patient] we would ? okay , thank you for explaining that .
[doctor] yeah . so i know it's annoying and distressing , but i think that's where we're at . it's annoying that you have the breast issue , and it's annoying that we have to follow them .
[patient] yeah , i agree there .
[doctor] um , but the only extra that i could po- , uh , potentially do , is we could get a breast specialist on the team and have you start to follow with them . and one of the advantages there is that they sometimes will do an ultrasound as an extension of their physical exam , in the office , to check out it- check it out on their own . uh , they also have a lot more experience and more willingness to sometimes perform procedures earlier , if they think it needs , um , if they think it needs to be done . and i think they tend to be much quicker than , you know , like radiology as to biopsy it .
[patient] okay . i'll do whatever you think i should .
[doctor] all right . well , i think since you're feeling worried , let's go ahead and we can get them on board . i'll send out a referral and they will call you within the next couple of business days to schedule .
[patient] okay , i think that sounds great .
[doctor] all right . i do too . all right , well any questions or anything else we can discuss today ?
[patient] no , i think i'm all set .
[doctor] all right , good . all right , well have a good rest of your day and just give us a call if you need anything else .
[patient] all right , thank you . you have a good day too .
[doctor] all right .

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