[doctor] thanks , rachel . nice , nice to meet you .
[patient] yeah .
[doctor] um , as my nurse told you , we're using dax . so i'm just gon na tell dax a little bit about you .
[patient] mm-hmm .
[doctor] so rachel is a 48-year-old female here for shortness of breath . she has a history of depression , smoking , and chronic back pain . so tell me about this shortness of breath .
[patient] okay . so there are times when i'm either doing very , very mild exercises or just walking , even if i'm just walking up , you know , my driveway , i find myself palpitating a lot , and there's a little bit of shortness of breath .
[doctor] mm-hmm .
[patient] i do n't know if it's got to do with the back pain , you know , whether that gets triggered as well at the same time .
[doctor] right .
[patient] but definitely i feel it happens more often lately .
[doctor] okay . and anything else change recently ? like , have you changed lifestyle , like you're exercising more than you used to , having any allergies , anything like that ?
[patient] probably exercising more to get rid of the covid 15 .
[doctor] the covid 15 . yeah . now last time i saw you , you were smoking two packs a day . how much are you smoking now ?
[patient] um , it's gone down quite a bit because , yeah , we said we have to make some , you know , changes as you get older .
[doctor] yeah .
[patient] so i would say it's probably , um , maybe , maybe a couple ... probably a coup- i do n't know . probably once or day or something .
[doctor] just couple cigarettes a day ?
[patient] probably once a day , yeah .
[doctor] we're getting close .
[patient] yeah .
[doctor] that's awesome .
[patient] mm-hmm .
[doctor] that's great news . um , and then how's your depression doing ?
[patient] i have my moments .
[doctor] yeah .
[patient] there are some days when i feel , you know , i wake up and everything was great .
[doctor] uh- .
[patient] and then there are times , i do n't , i do n't know whether it's got to do with the weather or what else kind of triggers it .
[doctor] yeah .
[patient] there are some days when i feel extremely low .
[doctor] okay . and you had been taking the effexor for your depression . are you still taking that ?
[patient] yes , i am .
[doctor] okay , great . and then , um the chronic back pain , we've been giving you the gabapentin neurontin for that . is that helping control the pain ?
[patient] i think it is .
[doctor] yeah .
[patient] it is ... it's definitely , um , i feel better .
[doctor] uh- .
[patient] but it does come every now and then .
[doctor] right . what do you do when it's really bad ?
[patient] um , i try to just get as much rest as i can .
[doctor] okay . and you had talked about doing yoga . are you doing yoga anymore ?
[patient] i wish i said yes , but i have n't really made it a habit .
[doctor] okay . okay . well , um , you know , said ... you said you were coming in with shortness of breath , so we sent you to get some pulmonary function tests .
[patient] mm-hmm .
[doctor] so let's just look at those . hey , dragon , show me the pulmonary function tests . okay , so it looks like ... , it's interesting . it says that you might be having a little bit of asthma or , uh , copd . and if you are , we'll talk about that .
[patient] mm-hmm .
[doctor] let's look at our x-ray . hey , dragon , show me the most recent x-ray . okay , i said it wrong . hey , dragon , show me the most recent chest x-ray . okay , this is interesting . your ... kind of your diaphragm is a little bit flatter , and we'll see that in some , uh , copd , which happens with smokers often . so let's just do a quick physical exam . i know my nurse did the review of systems with you . is there anything else bothering you that we need to talk about today ?
[patient] no other issues .
[doctor] okay . great . let's do the exam . all right , so your physical exam looks pretty normal other than you've got kind of these mild wheezes in all your lung fields . and so i think you do have copd from your pulmonary function tests , your x-ray , and that . so i'm gon na diagnose you with copd . chronic obstructive pulmonary disease . it means you're not able to exhale appropriately .
[patient] mm-hmm .
[doctor] so we're gon na put you on a medicine called combivent . okay , you're gon na do two puffs twice a day . it's gon na help open up your lungs . it's an inhaler .
[patient] mm-hmm .
[doctor] i'm also gon na prescribe albuterol , which you use when you get really short of breath . it's like a rescue thing .
[patient] mm-hmm .
[doctor] um , and then i'm gon na prescribe some steroids to help , also some prednisone . so let me just order those .
[patient] okay .
[doctor] hey , dragon , order combivent , uh , two puffs twice a day . order albuterol , two puffs as needed . and order , uh , prednisone uh taper pack . okay , so and then it sounds like your depression's stable , so we're not gon na change anything . you're gon na keep taking the effexor . um , do yoga for depression and your back pain , so for your back pain , stay on the neurontin , and we just wo n't do anything different . any questions for me .
[patient] no , i think this is good . thank you .
[doctor] perfect . hey , dragon , finalize the note . why do n't you ...

Medical orders:
description: combivent two puffs twice a day
order_type: medication
reason: chronic obstructive pulmonary diseas
description: albuterol two puffs as needed
order_type: medication
reason: short of breath
description: prednisone
order_type: medication
reason: chronic obstructive pulmonary diseas