[doctor] so beverly is a 53 -year-old female with a recent diagnosis of stage three nonsmile cell lung cancer who presents for follow-up during neo agit chemotherapy she was diagnosed with a four . four centimeter left upper lobe nodule biopsy was positive for adenocarcinoma molecular testing is pending at this time alright hello beverly how are you
[patient] i'm good today
[doctor] you're good today yeah you've been going through a lot lately i know you just had your treatment how how are your symptoms
[patient] my symptoms are pretty good today i just kind of have a minimal cough and a sore throat
[doctor] okay
[patient] but that's all i'm feeling today
[doctor] okay and how about fatigue have you been feeling more tired
[patient] yes a little bit
[doctor] okay and how about any nausea or vomiting
[patient] no not as of today
[doctor] okay and i know you were mentioning a cough before how is it as far as walking are you having any shortness of breath
[patient] i have n't noticed any shortness of breath it just kind of seems to be a lingering kind of light dry cough
[doctor] cough okay is it any mucus with it or is it a dry cough
[patient] more dry
[doctor] a dry cough okay and tell me more about this sore throat
[patient] this kind of seems to be persistent comes and goes it will be worse sometimes and then others it feels better trying to drink lots of fluids
[doctor] okay
[patient] to see if it can it you know the dry coughing if it's part of that or what i can do
[doctor] okay and when you mention drinking and eating is do you feel like anything is getting stuck there
[patient] no i do n't feel like anything is getting stuck right now and i have n't been i have been eating but not as much as i normally would
[doctor] okay okay alright and how are you doing as far as like just emotionally and mentally how are you doing i'm just talking a little bit about your support systems
[patient] the nursing staff and the office has been very good to help you know with anything that i need as far as support so just since we are just getting started so far on the journey i do feel like i have support and mentally you know still feel strong
[doctor] okay and how about with family or friends have you been able to turn to anyone
[patient] i do have good family members that have been supportive and they have come to my treatment with me
[doctor] okay excellent excellent and so right now you're on a combination of two different chemotherapies the cisplestan as well as the eupside and you had your last treatment just a few days ago but you're saying right now you've been able to tolerate the nausea and the fatigue
[patient] yes i have n't had any nausea but you know just slight fatigue it does n't seem to be overwhelming
[doctor] okay okay so we are gon na go ahead if it's okay with you and start your physical exam reviewing your vitals so vitals look good especially your oxygen especially with the chemotherapy you've been getting and the cough so your oxygen looks good so i'm happy with that so now i'm just examining your neck especially with your sore throat and i do n't appreciate any cervical lymphadenopathy and also no supraclavicular adenopathy listening to your heart you have a nice regular rate and rhythm with no murmurs that i appreciate now on your lung exam when you're taking some deep breaths i do notice some crackles in your lungs bilaterally and what that means is there is there is some faint sounds that i'm hearing which could represent some fluid there so on looking at your skin exam on your chest you do have some erythema on the anterior side of the chest on the left side and this could be related to the radiation so on your lower extremities i appreciate no edema and everything else looks good and thank you i know you did a chest x-ray before coming in so on your results for the chest x-ray it does look like you have some mild radiation pneumonitis which basically means some inflammation of the lungs most likely due to the radiation so what does this all mean so for your assessment and plan so for the first diagnosis the first problem of the lung cancer so what we're gon na do is we're gon na continue with the current regimen of your chemotherapy of the cisplacin and the etoside and we're gon na continue with your current dose of radiation at forty five grade and when that's complete we will repeat some imaging and hopefully you know the tumor will shrink down enough that we can remove it surgically okay for problem number two so the radiation pneumonitis so that's what causing that cough as well as some of the shortness of breath i know you're not experiencing it much now so what i'm gon na do for that is actually gon na prescribe you a low dose of prednisone and so that's an will help with the inflammation i'm gon na give you forty milligrams daily for five days and so hopefully that will help reduce the inflammation and so that you can continue with the radiation okay how does that sound so far
[patient] that sounds great thank you
[doctor] okay and then lastly for the painful swallowing that you're having so the inflammation you're having it not only in your lungs but it also in your esophagus as well so what i'm gon na do is prescribe you you're taking the the prednisone i'm also gon na give you a lidocaine swish and swallow and you can do that four times a day and so that will be able to help you so you can eat immediately after taking it and it can also help so that you can continue to take food and fluids prevent dehydration and any further weight loss
[patient] great
[doctor] okay any questions for me
[patient] i do n't believe so at this time
[doctor] okay alright so i'll see you at your next visit
[patient] great thank you
[doctor] you're welcome and so now just
CHIEF COMPLAINT

Follow up of stage III non-small cell lung cancer.

MEDICAL HISTORY

Patient reports history of stage III non-small cell lung cancer.

SOCIAL HISTORY

Patient reports having a good family support system and that some of her family has accompanied her to her chemotherapy sessions.

MEDICATIONS

Patient reports she is currently receiving chemotherapy treatment consisting of Cisplatin and etoposide.

REVIEW OF SYSTEMS

Constitutional: Reports fatigue and decrease in appetite.
HENT: Reports sore throat. Denies dysphagia.
Respiratory: Reports dry cough. Denies shortness of breath.
Gastrointestinal: Denies nausea or vomiting

VITALS

Vitals are within normal limits including oxygen saturation.

PHYSICAL EXAM

Neck
No cervical lymphadenopathy or supraclavicular adenopathy.

Respiratory
- Auscultation of Lungs: Crackles heard bilaterally.

Cardiovascular
- Auscultation of Heart: Regular rate and rhythm. No murmurs.

Musculoskeletal
- Examination: No edema.

Integumentary
- Erythema noted on the anterior side of the chest on the left side possibly related to radiation.

Hematology/Lymphatic/Immunology
- Palpation: No enlarged lymph nodes.

RESULTS

Chest x-ray is reviewed and demonstrates mild radiation pneumonitis.

ASSESSMENT AND PLAN

1. Stage III non-small cell lung cancer.
- Medical Reasoning: The patient has a recent diagnosis of stage III non-small cell lung cancer. Biopsy was positive for adenocarcinoma. Molecular testing is pending at this time.
- Medical Treatment: We are going to continue with the current regimen of combination chemotherapy consisting of Cisplatin and etoposide. We are also going to continue with her current dose of radiation at 45 Gy. Once this is complete, we will obtain repeat imaging in hopes that the tumor will decrease in size enough for surgical removal.

2. Radiation pneumonitis.
- Medical Reasoning: The patient is experiencing a persistent dry cough. Recent x-rays are reviewed and demonstrated evidence of mild radiation pneumonitis.
- Patient Education and Counseling: We discussed the etiology of her dry cough is from her mild radiation pneumonitis.
- Medical Treatment: A prescription of prednisone 40 mg daily for 5 days is provided to help with her inflammation.

3. Painful swallowing.
- Medical Reasoning: The patient is experiencing painful swallowing secondary to inflammation of the esophagus.
- Patient Education and Counseling: We discussed the etiology of her painful swallowing and that a lidocaine viscous solution will be beneficial in preventing dehydration and any further weight loss.
- Medical Treatment: A lidocaine viscous solution was provided to be performed 4 times daily.

Patient Agreements: The patient understands and agrees with the recommended medical treatment plan.

INSTRUCTIONS

The patient will return to clinic at her next scheduled follow up.