[doctor] hi keith , how are you ?
[patient] ah , not too good . my blood sugar is n't under control .
[doctor] and , uh , so keith is a 58-year-old male here for evaluation of high blood sugar . so , what happened ? ha- have you just been taking your blood sugars at home and noticed that they're really high ? or ?
[patient] yeah i've been taking them at home and i feel like they've been creeping up slightly .
[doctor] have- ... what have they been running , in like the 200's or 300's ?
[patient] 300's .
[doctor] they've been running in the 300's ? and tell me about your diet . have you been eating anything to spark- ... spike them up ?
[patient] to be honest my diet has n't changed much .
[doctor] okay . have you- ... go ahead .
[patient] actually it has n't changed at all . much of the same .
[doctor] okay and what do you con- consider the same ? are you eating lots of sugar ? like , teas and coffees and-
[patient] i do n't take sugar with my tea .
[doctor] okay , all right . and how about , um , like any added sugars into any kind of processed foods or anything like that ?
[patient] uh , i think most of my sugars come from fruit .
[doctor] from what ?
[patient] fruit .
[doctor] fruit , okay .
[patient] yeah .
[doctor] all right . um , and have you been feeling sick recently ? have you had any fever or chills ?
[patient] uh , i have not .
[doctor] body aches , joint pain ?
[patient] uh , a bit of joint pain .
[doctor] multiple joints , or just one joint ?
[patient] uh , my knee . uh , sorry , right knee to be more exact .
[doctor] your right knee ?
[patient] yeah .
[doctor] okay . and what happened ?
[patient] ah , to be honest , nothing much . i just noticed it when you said it .
[doctor] okay , all right . um , and how about any nausea or vomiting or belly pain ?
[patient] uh , i was nauseous a couple of days back but , uh , that's just because i was sitting in the back of a car . i hate that .
[doctor] okay . all right . and no burning when you urinate or anything like that ?
[patient] not at all .
[doctor] okay . all right . so , um ... you know , i know that you've had this reflux in the past . how are you doing with that ? are you still having a lot of reflux symptoms or do you feel like it's better since we've put you on the protonix ?
[patient] i think it's a bit better . uh , i do n't get up at night anymore with reflux and that's always a good thing .
[doctor] okay , all right . and i know you have this history of congestive heart failure . have you noticed any recent , uh , weight gain or fluid retention ?
[patient] um , not really .
[doctor] no ? okay . um , and any problems sleeping while laying flat ?
[patient] uh , i- i prefer to sleep on my side so i ca n't really say .
[doctor] okay , but even then , you're flat .
[patient] yup , yeah .
[doctor] okay . all right . and i know that we had an issue with your right rotator cuff , is that okay ?
[patient] it's surprisingly good now .
[doctor] okay , all right . all right , well let's go ahead and we'll do a quick physical exam . so ... feeling your neck , i do feel like your thyroid's a bit enlarged here . um , your heart is nice and regular . your lungs are clear . your abdomen , um , is nice and soft . your right knee shows that you have some erythema and- and an insect bite with associated fluctuants . and , um , you have some lower extremity edema on the right hand side . so let's go ahead and look at some of your results . i know the nurse had reported these things and we ordered some labs on you before you came in . hey dragon , show me the vital signs . okay , well your- your vital signs look good , which is good . hey dragon , show me the lyme titer . okay , so , you know , your lyme titer is a little elevated , so i think we'll have to go ahead and- and look into that a little bit , okay ?
[patient] makes sense .
[doctor] that can certainly cause your blood sugar to be elevated . um , hey dragon , uh , show me the rapid strep . and you also have , uh , positive for strep . so i think we have some reasons as to why your blood sugar is so high . so my impression of you , you know , you have this hyperglycemia , which is probably related to some infections going on in your body . um , from a- a- a rapid strep standpoint we're gon na go ahead and treat you with penicillin or , i'm sorry , amoxicillin , 500 milligrams , three times a day . uh , make sure you take it all , even if you start feeling better , okay ?
[patient] for sure .
[doctor] hey dragon , order amoxicillin , 500 milligrams , three times a day for 10 days . um ... okay . and from ... , and from all- ... a positive lyme titer aspect , we should go ahead and order a western blot , just pcr to see if you have any , um , to see if it's actually acute lyme , okay ?
[patient] okay .
[doctor] okay . um , hey dragon , order a western blot pcr for lyme . okay . all right . well we'll go ahead and , um , the nurse will come in soon and she'll set you up with these tests , okay ?
[patient] yeah . you said lyme . is that related to lyme disease ?
[doctor] yes it is , yeah .
[patient] you're certain i do n't have alpha-gal syndrome though , right ? i'm terrified of that one .
[doctor] have what ?
[patient] alpha-gal syndrome , the one where a tick bites you and you get an allergic reaction to meat .
[doctor] yeah , i do n't think so . have you eaten meat over the last couple of days ?
[patient] i have .
[doctor] okay . well i- ... it's , you know , your blood sugar's elevated so you might be having an inflammatory response to that , but we'll go ahead and order some tests to look into it , okay ?
[patient] that sounds good .
[doctor] all right . call me if anything happens , okay ?
[patient] definitely .
[doctor] all right . hey dragon , finalize the note .

Medical orders:
description: amoxicillin 500 milligrams three times a day 10 day
order_type: medication
reason: positive for strep
description: western blot pcr
order_type: lab
reason: lyme