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Aug 21 07:15
• This is a gentleman who is status post injury. He has evidence of the ...
+ mp3
Thu Aug 22 01:58:19 2019 mp3
This is a gentleman who is status post injury. He has evidence of the long head biceps tendon rupture. He has failed to improved despite conservative measures. He seems to have residual stump of biceps tendon in the glenohumeral joint based on the MRI. He also has AC joint osteoarthritis which appears to be symptomatic as well as ______ findings. He has failed conservative measures including injection.

• POSTOPERATIVE DIAGNOSES: 1. Retrocalcaneal exostosis with Achilles ins ...
+ mp3
Thu Aug 22 01:00:44 2019 mp3
POSTOPERATIVE DIAGNOSES: 1. Retrocalcaneal exostosis with Achilles insertional tendinopathy, right heel.
2. ______ sharp pointed superior ______ Haglunds protrusion and irritation to tendon.

PROCEDURES PERFORMED: 1. Secondary ______ Achilles tendon, right ankle.
2. Excision of Haglunds deformity and calcaneal exostectomy after detachment was accomplished, right heel.

** • #3 repair of - Q
Thu Aug 22 01:56:50 2019 Q

** • #1 & #2 Extremely sharp-pointed superior tuberous Haglund's etc - Questyr
Thu Aug 22 01:55:50 2019 Questyr

**** • Thanks a lot. :-) - guy
Thu Aug 22 01:58:45 2019 guy

** • never mind. Thanks to anyone who tried. - guy
Thu Aug 22 01:23:06 2019 guy


• We have discussed options of HA augmentation of the temple versus fat ...
+ mp3
Thu Aug 22 00:44:13 2019 mp3
We have discussed options of HA augmentation of the temple versus fat transfer. He elected to proceed with ______ Juvederm Vollure XE for the temple today. The skin was prepped with alcohol and BLT cream.
** • to the temple (not for the) - poi
Thu Aug 22 00:46:19 2019 poi

**** • Thanks for the correction. - guy
Thu Aug 22 01:01:08 2019 guy

** • one syringe of - poi
Thu Aug 22 00:45:51 2019 poi

**** • Thanks a lot. :-) - guy
Thu Aug 22 00:46:16 2019 guy


• Patient in light of her bruising history, has decided to start with Bo ...
+ mp3
Thu Aug 22 00:31:14 2019 mp3
Patient in light of her bruising history, has decided to start with Botox. We have placed a total of 50 units of Allergan botulinum toxin type A divided between crow's feet, glabella, forehead, and the ______ at the marionette line. She tolerated the procedure well after the skin was prepped with alcohol and BLT cream. She will follow up in approximately three weeks for re-evaluation and go from there.
** • then down at the?? (guess) - poi
Thu Aug 22 00:43:24 2019 poi

**** • Thanks a lot. :-) - guy
Thu Aug 22 00:43:58 2019 guy


• Patient is planning on becoming pregnant again and we have discussed m ...
+ mp3
Thu Aug 22 00:26:34 2019 mp3
Patient is planning on becoming pregnant again and we have discussed may be using minimal sunscreens. We have also discussed ______ and we have discussed Botox as well as fillers.
** • the Clarisonic - poi
Thu Aug 22 00:30:25 2019 poi

** • mineral sunscreens (not minimal) - poi
Thu Aug 22 00:29:39 2019 poi

**** • Thanks a lot. Thanks for the correction. - guy
Thu Aug 22 00:30:52 2019 guy


• POSTOPERATIVE DIAGNOSIS: Right carpal tunnel syndrome and ______ comp ...
+ mp3
Wed Aug 21 23:11:01 2019 mp3
POSTOPERATIVE DIAGNOSIS: Right carpal tunnel syndrome and ______ compression of Guyons canal.

PROCEDURE: Right carpal tunnel decompression, release of right Guyons canal, 64721 and 64719-59.

** • I just hear a stumble - fwiw-poi
Wed Aug 21 23:17:20 2019 fwiw-poi

**** • Thanks a lot. :-) - guy
Wed Aug 21 23:26:30 2019 guy


• The fracture was not reduced percutaneously, therefore an extended inc ...
+ mp3
Wed Aug 21 21:06:12 2019 mp3
The fracture was not reduced percutaneously, therefore an extended incision was made for 4 cm and the area was freed and then tenaculum was used to reduce the fracture. ______ and AP and lateral views were obtained demonstrating standard fixation. A 60 x 4.5 mm cannulated Synthes screw was in place, compressed the fracture ______ anatomic reduction. Copious irrigation was then carried out and closure was carried out with 2-0 nylon
** • A guidewire was then placed in the direction of the _____ (what kind of fracture?) - poi
Wed Aug 21 21:19:13 2019 poi

**** • POSTOPERATIVE DIAGNOSES: 1. Right fourth and displaced fifth metata ... + guy
Wed Aug 21 21:22:53 2019 guy
POSTOPERATIVE DIAGNOSES:
1. Right fourth and displaced fifth metatarsal fracture (Jones fracture).
2. Right foot pain.

TITLE OF OPERATION:
Right foot open reduction and internal fixation with intramedullary screw.

** • 2. into near - poi
Wed Aug 21 21:16:41 2019 poi

**** • Thanks a lot. :-) - guy
Wed Aug 21 21:21:53 2019 guy


• The patient is a pleasant 61-year-old retired police officer who suffe ...
+ mp3
Wed Aug 21 20:46:40 2019 mp3
The patient is a pleasant 61-year-old retired police officer who suffered a foot fracture with a ______. The patient was seen and worked up at outside facility and referred for orthopedic consultation. The patient presented to clinic with a displaced fifth metatarsal fracture.
** • misstep - mn
Wed Aug 21 20:52:36 2019 mn

**** • Thanks a lot. :-) - guy
Wed Aug 21 21:00:10 2019 guy


• ortho, sm for context, s/l pom-pless-oj (pomplessage)
+ gz
Wed Aug 21 13:34:17 2019 gz
Shoulder surgery:

Complex capsulolabral repair; **pomplessage plication of infraspinatus/capsule.

** • got it: remplissage - gz
Wed Aug 21 13:37:41 2019 gz


• AC joint repair: "I did not have a biologic available for doing a *mizoka* technique"
- CO MT
Wed Aug 21 11:54:25 2019 CO MT

** • Mazzocca, found by googling, am not familiar with the term, so you might - want to confirm.
Wed Aug 21 12:14:49 2019 want to confirm.

**** • Thanks, I sent in the blank. I'll come back if QA fills it in - CO MT
Wed Aug 21 12:16:47 2019 CO MT

****** • Well, they must not have tried too hard. They left the blank - CO MT
Wed Aug 21 12:21:03 2019 CO MT

******** • Thanks for letting us know. - h b p c n p
Wed Aug 21 12:59:41 2019 h b p c n p

********** • You're welcome. Thanks for all who tried - CO MT
Wed Aug 21 17:16:47 2019 CO MT

** • Sorry, I had no luck. - Questyr
Wed Aug 21 12:11:21 2019 Questyr

** • Blanking - CO MT
Wed Aug 21 12:07:54 2019 CO MT


• CURRENT MEDICATIONS: She current takes Synthroid, ______ and 81 mg as ...
+ mp3
Wed Aug 21 03:03:29 2019 mp3
CURRENT MEDICATIONS: She current takes Synthroid, ______ and 81 mg aspirin as well as multiple vitamins.
** • Dexilant - ltt
Wed Aug 21 06:04:52 2019 ltt

**** • Thanks a lot. :-) - guy
Wed Aug 21 21:00:20 2019 guy

** • never mind. Thanks to anyone who tried. - guy
Wed Aug 21 03:09:46 2019 guy


• POSTOPERATIVE DIAGNOSIS: Left distal biceps tendon rupture. PRO ...
+ mp3
Wed Aug 21 02:06:14 2019 mp3
POSTOPERATIVE DIAGNOSIS: Left distal biceps tendon rupture.

PROCEDURE PERFORMED: Reinsertion of left distal biceps tendon.

The patient was correctly identified in the preoperative holding area and the operative site was marked by me personally. The patient was brought to the operating suite. The patient was placed supine on the operating table and had all bony prominences padded. After obtaining general anesthesia, the limb was prepped and draped in the routine surgical fashion. Bony landmarks were palpated and outlined, and a standard transverse incision was made based over the antecubital fossa. Careful meticulous, high-loupe dissection proceeded through the skin and subcutaneous tissue down to the level of the ______ the biceps tendon stump was identified. This was carefully retracted out of the wound and the distal stump was freshened using a #15 Bard-Parker blade.
** • He changes his mind to "level adjacent to the lacertus. The " etc - Questyr
Wed Aug 21 02:15:07 2019 Questyr

**** • Thanks a lot. Thanks for the correction. - guy
Wed Aug 21 02:17:52 2019 guy

** • No...give me a minute to research what it is - Questyr
Wed Aug 21 02:12:48 2019 Questyr

**** • Thanks a lot. :-) + guy
Wed Aug 21 02:16:55 2019 guy
down to the level of the lacertus. Adjacent to the lacertus, the biceps tendon stump was identified.

• The patient was correctly identified in the preoperative holding area ...
+ mp3
Wed Aug 21 01:00:11 2019 mp3
The patient was correctly identified in the preoperative holding area and the operative site was marked by me personally. The patient was brought to the operative suite and placed supine on the operating table and had all bony prominences padded. After obtaining general anesthesia, the limb was prepped and draped in the routine surgical fashion. Bony landmarks were palpated and outlined and a standard longitudinal incision was made based over the mass. Careful meticulous high-loupe dissection proceeded. Meticulous hemostasis was achieved along the way using electrocautery. The bursa was encountered medially and appeared to be consistent with tophaceous bursitis. This was circumferentially dissected and removed as specimen. There was extensive tophaceous ______ in the triceps insertion to involve compromising approximately 50% of the attachment.
** • replacement - Questyr
Wed Aug 21 01:07:11 2019 Questyr

**** • Q, in following post also replacement? mp3 posted. thanks. - guy
Wed Aug 21 01:08:52 2019 guy

**** • Thanks a lot. :-) - guy
Wed Aug 21 01:08:15 2019 guy


• POSTOPERATIVE DIAGNOSIS: Chronic olecranon bursitis. PROCEDURE ...
+ mp3
Wed Aug 21 00:42:50 2019 mp3
POSTOPERATIVE DIAGNOSIS: Chronic olecranon bursitis.

PROCEDURE PERFORMED: Excision of olecranon bursa, left elbow.

INDINGS: Include gouty tophaceous tissue ______ triceps insertion for approximately 50% of the attachment.
** • which has displaced the - what I hear
Wed Aug 21 00:58:23 2019 what I hear

**** • Thanks a lot. :-) - guy
Wed Aug 21 01:00:26 2019 guy


• After the patient was consented, given preoperative antibiotics, DVT p ...
+ mp3
Tue Aug 20 23:37:12 2019 mp3
After the patient was consented, given preoperative antibiotics, DVT prophylaxis instituted, laryngeal mask anesthesia was induced by Dr. and prepped and draped in the standard surgical fashion. Attention was directed to the patients right groin where skin incision was made after local anesthetic was provided and carried down with a Bovie cautery. The greater saphenous vein was identified. It was previously ablated; however, it was ligated. Secondary varicosities off of the saphenofemoral junction were also identified and ligated including a large redundant secondary vein near the saphenofemoral junction. They were ligated proximally and distally and oversewn with 2-0 Vicryl stick tie. Once this was accomplished, a multilayered closure performed with 3-0 Vicryl and 4-0 Monocryl. Dermabond was placed in the groin. The patient tolerated that portion of the procedure well. Previously marked varicosities on the right lower extremity were removed with a stab incision. Stab phlebe
** • I keep hearing "Kerlix with gauze" - Questyr
Wed Aug 21 00:06:18 2019 Questyr

**** • FWIW I checked transcription samples (see link) and am not finding + Q
Wed Aug 21 00:20:12 2019 Q
the use of wet (or wet-to-dry) dressings at the end of the surgery.
****** • Note: I only read the first 5 sample reports. - Q
Wed Aug 21 00:21:19 2019 Q

******** • Thanks a lot. :-) - guy
Wed Aug 21 00:43:28 2019 guy

**** • Thanks a lot. :-) - guy
Wed Aug 21 00:08:22 2019 guy

** • Kerlix wet gauze - poi
Tue Aug 20 23:40:36 2019 poi

**** • Q is correct (again). I better slow down or not try to help at all! - poi
Wed Aug 21 12:40:20 2019 poi

**** • Thanks a lot. :-) - guy
Tue Aug 20 23:40:51 2019 guy


• POSTOPERATIVE DIAGNOSIS: Bilateral mixed hearing loss with bilatera ...
+ mp3
Tue Aug 20 22:30:17 2019 mp3
POSTOPERATIVE DIAGNOSIS:
Bilateral mixed hearing loss with bilateral middle ear effusions.

TITLE OF OPERATION:
Bilateral myringotomy with pressure equalization tube placement.

With the patient supine on the operating table, general anesthesia was induced and an LMA was placed. A surgical time-out was performed and the operating microscope was brought into position over the patients right ear. The tympanic membrane was brought into focus and ______ was applied to the tympanic membrane.
** • Phenol - poi
Tue Aug 20 23:09:42 2019 poi

**** • Thanks a lot. :-) - guy
Tue Aug 20 23:37:26 2019 guy

** • never mind. Thanks to anyone who tried. - guy
Tue Aug 20 22:44:18 2019 guy


• The patient presented with his mother today with a new growth involvin ...
+ mp3
Tue Aug 20 22:09:27 2019 mp3
The patient presented with his mother today with a new growth involving the left lower lid. He had blepharotomies on the right side in the past with recurrence of the right upper lid and now a new collection formation of the left lower lid. An extensive history was obtained to rule out any unusual circumstances for this continued and multiple eyelid involvement with chalazia and sterile abscess formation. A granuloma was noted in the left lower lid on the conjunctival aspect of the palpebral conjunctiva. Extensive counselling of the mother and medical treatment, short of doxycycline, was discussed and started including warm compresses, ______, Avenova spray, topical ointment, and lid hygiene.
** • lid scrubs? - billybob
Tue Aug 20 22:17:03 2019 billybob

**** • Thanks a lot. :-) - guy
Tue Aug 20 22:17:32 2019 guy


• ...on the palm. ___________________ Dupuytren's affecting ...
+ wav
Tue Aug 20 17:28:03 2019 wav
The patient again had a history of some Dupuytrens nodules on the palm. ___________________ Dupuytren's affecting again the joint to the left small finger PIP. The smaller nodule was excised and sent as well.
** • ... - wav deleted
Tue Aug 20 17:29:49 2019 wav deleted


• Which is correct: pedicled TRAM flap or pedicle TRAM flap?
- TIA
Tue Aug 20 15:53:41 2019 TIA

** • pedicle TRAM flap (see link) + Questyr
Tue Aug 20 20:32:38 2019 Questyr
link
** • I am using pedicled. Thanks - TIA
Tue Aug 20 16:04:28 2019 TIA


• Dictated: On July 8th of 2019. Do I type July 8 of 2019? Thanks
- k e g k g l
Tue Aug 20 15:38:26 2019 k e g k g l

** • I'm assuming you are referring to a sentence in the body of the + Q
Tue Aug 20 15:47:08 2019 Q
report and not a type of statistic at the end of the report such as
D: 7/8/2019
**** • Yes, a sentence. Thanks Q - k e g k g l
Tue Aug 20 15:48:09 2019 k e g k g l

** • I would do July 8, 2019 IMO - Questyr
Tue Aug 20 15:44:48 2019 Questyr

**** • or even 7/8/2019 - Q
Tue Aug 20 15:45:34 2019 Q


• episodes of agitation, s/l*gradu-aucity** and lability.
+ Psych
Tue Aug 20 10:32:44 2019 Psych
The patient continues with multiple episodes of agitation, s/l*gradu-aucity** and lability.

He was resistant to staff directions, singing then yelling s/l*graduity" statements, "I write all the songs in the world."
** • 1) grandiosity and lability 2) gratuitous statements - nm
Tue Aug 20 10:39:36 2019 nm

**** • Thank you!!! - OP
Tue Aug 20 10:41:30 2019 OP


• final assessment notes. Dr. X has s/l re vade this patient's case.
+ see mess
Tue Aug 20 08:42:16 2019 see mess
I believe this patient has had either additional cardiac outpatient medical records through the present and/or evaluations. Somewhere in my chart it appears that Dr. X has s/l re vade this patient's case.
** • and/or is not correct - fyi
Tue Aug 20 10:41:03 2019 fyi

**** • nevermind - oops
Tue Aug 20 10:45:57 2019 oops

** • re-evaluated? - c i j i g e
Tue Aug 20 09:20:01 2019 c i j i g e

** • reviewed ? (dictator mis-pronouncing or slurring a bit ??) - c i j i g e
Tue Aug 20 09:19:25 2019 c i j i g e

**** • going with reviewed - TY
Tue Aug 20 09:35:10 2019 TY


• Both metacarpals are in line w/ each other, making it a *double I formation*
+ sm
Tue Aug 20 07:52:28 2019 sm
4th and 5th metacarpal synostosis with both metacarpals in line with each other, making it a *double I formation* with the 5th metacarpal being slightly a bit smaller. It is almost a complete synostosis going about 75% of the way up.


** • could be. Alphabet letters used to describe synostosis types. See msg + c i j i g e
Tue Aug 20 08:05:09 2019 c i j i g e
Foucher et al1 used letters of the alphabet (I,U,Y,k)
to describe different types of the synostosis (from article in attached link)
**** • Thank you :) - OP
Tue Aug 20 08:47:40 2019 OP


• POSTOPERATIVE DIAGNOSES: 1. Chronic abdominal pain. 2. Incomplet ...
+ mp3
Tue Aug 20 02:26:44 2019 mp3
POSTOPERATIVE DIAGNOSES:
1. Chronic abdominal pain.
2. Incomplete ______.

Procedure not dictated
** • incomplete quadraplegia - mn
Tue Aug 20 07:09:07 2019 mn

** • The patient presents for spinal cord stimulator trial as the patient h ... + guy
Tue Aug 20 02:27:37 2019 guy
The patient presents for spinal cord stimulator trial as the patient has failed all of her treatments to try to control his chronic severe abdominal pain. Procedure was discussed in detail with the patient and his wife. The patient understands the procedure and gives informed consent.

• The patient presents with compression fracture at T8. The patient has ...
+ mp3
Tue Aug 20 01:27:06 2019 mp3
The patient presents with compression fracture at T8. The patient has a previous fusion ______ T9 with posterior fusion hardware in place. The procedure was discussed in detail with the patient and her husband. They both understood the procedure and ______ risk.
** • never mind. Thanks to anyone who tried. - guy
Tue Aug 20 01:50:43 2019 guy


• The lateral joint line showed no significant chondromalacia. There wa ...
+ mp3
Tue Aug 20 00:41:52 2019 mp3
The lateral joint line showed no significant chondromalacia. There was a vertical tear with a small radial component in the posterior horn of the lateral meniscus. This was debrided and ______ trephines and placed two Smith & Nephew Fast-Fix 360 sutures across the vertical tear. The sutures were placed across the small radial component.
** • rasped? - poi
Tue Aug 20 00:43:55 2019 poi

** • rasped with - Questyr
Tue Aug 20 00:43:47 2019 Questyr

**** • Change that to "rasped and trephined" - Q
Tue Aug 20 00:44:16 2019 Q

****** • Thanks a lot everybody. - guy
Tue Aug 20 00:47:34 2019 guy


• Inspection of the glenohumeral joint demonstrated the superior labrum ...
+ mp3
Tue Aug 20 00:26:34 2019 mp3
Inspection of the glenohumeral joint demonstrated the superior labrum to have some mild fraying. This was debrided ______ subscapularis tendon was in good condition. The anterior labrum had a small tear in the anterior-inferior portion that was debrided and the chondral surfaces were in good condition.
** • never mind. Thanks to anyone who tried. - guy
Tue Aug 20 00:35:24 2019 guy


• The patient was taken to the operating room and placed in the supine p ...
+ mp3
Tue Aug 20 00:21:37 2019 mp3
The patient was taken to the operating room and placed in the supine position. After administration of general anesthetic, the right upper extremity was examined under anesthesia. He had a full range of motion with no instability. There was no evidence of restriction of motion ______ adhesive capsulitis on his exam.
** • motion, i.e. of adhesive capsulitis... - billybob
Tue Aug 20 00:23:51 2019 billybob

**** • Thanks a lot. - guy
Tue Aug 20 00:26:13 2019 guy


• POSTOPERATIVE DIAGNOSES: 1. Right knee complete ACL tear. 2. Poste ...
+ mp3
Mon Aug 19 23:47:43 2019 mp3
POSTOPERATIVE DIAGNOSES: 1. Right knee complete ACL tear.
2. Posterior horn lateral meniscal tear.

PROCEDURES PERFORMED: 1. Right knee arthroscopy with arthroscopically-aided RTI anterior tibialis allograft ACL reconstruction with Mitek RigidFix and MedShape 9 mm x 25 mm implant, (CPT 29888).
2. Lateral meniscal repair with Smith & Nephew ______ sutures x2, (CPT 29882).

** • I think he might be saying Fast-Fix 360 (see link) + Questyr
Tue Aug 20 00:12:54 2019 Questyr
link
**** • Thanks a lot. - guy
Tue Aug 20 00:14:54 2019 guy

**** • that's it! Fast-Fix - agree-poi
Tue Aug 20 00:14:54 2019 agree-poi

** • plastic? - poi
Mon Aug 19 23:50:15 2019 poi

**** • Thanks a lot. - guy
Mon Aug 19 23:50:32 2019 guy

**** • plastic 360 sutures - poi
Mon Aug 19 23:50:28 2019 poi


• POSTOPERATIVE DIAGNOSES: 1. Right knee complete ACL tear. 2. Compl ...
+ mp3
Mon Aug 19 22:57:46 2019 mp3
POSTOPERATIVE DIAGNOSES: 1. Right knee complete ACL tear.
2. Complex tear, body and posterior horn medial meniscus.
3. Complex tear, body lateral meniscus.

PROCEDURES PERFORMED: 1. Right knee arthroscopy with arthroscopically-aided RTI anterior tibialis allograft ACL reconstruction with Mitek RigidFix and MedShape ExoShape 9 mm x 30 mm fixation, (CPT 29888).
2. Partial medial and lateral meniscectomies, (CPT 29880).

Patient is a 30-year-old female who sustained an ACL tear, and medial and lateral meniscal tears, and a work injury over nine months ago. She is having persistent instability. I have discussed with her ACL reconstruction with allograft tendon as well as medial and lateral meniscectomies. I have gone over the risks and complications associated with the procedure as well as the postoperative rehabilitation and expectations. She understands these and desires to proceed.

The patient was taken to the operating room and placed in the supine po
** • might be ???lateral??? - Questyr
Mon Aug 19 23:26:33 2019 Questyr

**** • see link + Q
Mon Aug 19 23:28:38 2019 Q
link
****** • is that what you hear? - poi
Mon Aug 19 23:34:04 2019 poi

******** • I kept the ???s because I don't clearly hear, but I think I hear + Q
Mon Aug 19 23:37:32 2019 Q
lateral and the ACL Guy's.
********** • was just curious since we are so far off on what we hear. I found lots of other + thanks- poi
Mon Aug 19 23:40:58 2019 thanks- poi
possibilities when googling (including lateral), just couldn't hear any of them.
********** • Some kind of keyboard error...amendment...and the ACL context is + Q
Mon Aug 19 23:38:51 2019 Q
supported in the lateral pivot shift articles.
************ • amendment continued. The kept the ???s because it needs + Q
Mon Aug 19 23:40:03 2019 Q
confirmation by better ears than mine such as yours and Guy's.
************** • I appreciate your effort. But your's are definitely better than mine. :-) - guy
Mon Aug 19 23:48:52 2019 guy

** • violent? - poi
Mon Aug 19 23:24:31 2019 poi

**** • I did read it can be described as "more severe jerk (Grade 2)", so I feel my answer + fwiw-poi
Mon Aug 19 23:26:41 2019 fwiw-poi
is possible
****** • Thanks a lot everybody. - guy
Mon Aug 19 23:35:03 2019 guy


• This case required the use of a trained surgical assistant for positio ...
+ mp3
Mon Aug 19 22:38:05 2019 mp3
This case required the use of a trained surgical assistant for positioning of the shoulder ______ extremely difficult arthroscopy due to the arthritis.
** • ???as it was an??? - Questyr
Mon Aug 19 22:48:48 2019 Questyr

**** • Thanks a lot. - guy
Mon Aug 19 22:49:52 2019 guy


• It was extremely difficult to get the scope in the joint, but eventual ...
+ mp3
Mon Aug 19 22:26:21 2019 mp3
It was extremely difficult to get the scope in the joint, but eventually I managed to get it in, a little higher than usual, through a posterior approach. The joint, as expected, was severely degenerative. I thoroughly evaluated the superior labrum and did not see any evidence of biceps tendon within the joint. The subscapularis tendon was not easily visualized ______ fibers of the superior aspect. The anterior capsule was thickened, but had a significant postoperative appearance _____ that a release would help. The chondral surfaces were, as expected, had severe arthritis.
** • NOTE: The last sentence has 2 verbs. Suggest you change to "had, as expected, severe" etc - Q
Mon Aug 19 22:34:45 2019 Q

**** • Thanks for the correction. - guy
Mon Aug 19 22:37:40 2019 guy

** • I think with #2 he changes to "and it did not appear" - Questyr
Mon Aug 19 22:32:37 2019 Questyr

**** • Thanks a lot. - guy
Mon Aug 19 22:37:29 2019 guy


• This case was ______ difficult than standard anterior labral repair as ...
+ mp3
Mon Aug 19 22:02:24 2019 mp3
This case was ______ difficult than standard anterior labral repair as it required a remplissage posteriorly adding extra time and effort on the surgeons part for the case.
** • significantly more difficult than A - poi
Mon Aug 19 22:03:34 2019 poi

**** • Thanks a lot. - guy
Mon Aug 19 22:05:20 2019 guy


• The scope was then placed posteriorly. The anterior labrum was elevat ...
+ mp3
Mon Aug 19 21:48:43 2019 mp3
The scope was then placed posteriorly. The anterior labrum was elevated from its medialized position. There was still some reasonable labrum and capsule, especially inferiorly. I debrided the anterior glenoid of soft tissues and prepared the bony bed. I placed the ConMed Y-Knot Flex double-loaded anchors at approximately the 5 oclock position and passed the two sutures through the capsule and labrum, advancing it superiorly. There was a small piece of bone that was incorporated in this as well. I then placed three more of the Y-Knot Flex anchors at the 4, 3, and 2 oclock position. Both sutures were passed through the capsulolabral complex and tied with sliding knots. _____ superior anchor, I was able to grab the torn portion of the anterior capsule and incorporated into the repair.
** • incorporate it into the repair - poi
Mon Aug 19 22:02:46 2019 poi

**** • Thanks for the correction. - guy
Mon Aug 19 22:05:43 2019 guy

** • The more? most? - poi
Mon Aug 19 22:01:39 2019 poi

**** • Thanks a lot. - guy
Mon Aug 19 22:02:09 2019 guy


• POSTOPERATIVE DIAGNOSIS: Left shoulder grade 3 anterior instability. ...
+ mp3
Mon Aug 19 21:17:22 2019 mp3
POSTOPERATIVE DIAGNOSIS: Left shoulder grade 3 anterior instability.

PROCEDURE PERFORMED: Left shoulder arthroscopy with arthroscopic anterior labral reconstruction with ConMed Y-Knot Flex 1.8 mm double-loaded anchors x4 with remplissage using ConMed Y-Knot RC anchors x2, (CPT 29806-22).

Patient is a 33-year-old gentleman who has had multiple recurrent dislocations of his shoulder. The MRIs demonstrate approximately 13% glenoid bone loss with an off-track glenoid. I discussed with him several options including anterior labral reconstruction with remplissage or ______. Given the relatively minor bone loss, we feel that anterior labral repair with remplissage is reasonable.
** • Latarjet - poi
Mon Aug 19 21:19:35 2019 poi

**** • Thanks a lot. :-) - guy
Mon Aug 19 21:20:32 2019 guy


• Silicone oil washout with air/fluid exchange was performed x3 to the p ...
+ mp3
Mon Aug 19 16:17:40 2019 mp3
Silicone oil washout with air/fluid exchange was performed x3 to the posterior ____________ once view was adequate.
** • to the posterior, once view was adequate (I think he is just stumbling) - gz
Mon Aug 19 16:28:05 2019 gz

**** • Thanks, gz - mp3
Mon Aug 19 16:55:18 2019 mp3


• Oral surgery. she was given s/l*a-bev-lind* during the procedure and OB/GYN is aware
+ Please SM
Mon Aug 19 15:40:20 2019 Please SM
extraction of four wisdom teeth. She did well. Her postoperative course was complicated by an unknown pregnancy. She is approximately 7 weeks currently. We did discuss with her today that she was given s/l*a-bev-lind* during the procedure and OB/GYN is aware.

• Tinel's noted over "DPN" secondary to ulceration?
+ Julie
Mon Aug 19 15:39:57 2019 Julie
This is regarding a right foot ulcer. Sounds like DPN? Thanks
** • deep peroneal nerve - gz
Mon Aug 19 16:12:44 2019 gz


• ...deep, the lens _____ posterior very difficult access....
+ wav
Mon Aug 19 15:37:37 2019 wav
The eye was very large, severe high myopia, with difficult access into the anterior chamber and very deep, the lens _____ posterior very difficult access in all respects for the procedure.
** • ? was so posterior it was very difficult to access - gz
Mon Aug 19 16:11:35 2019 gz

**** • Thanks, gz - wav
Mon Aug 19 16:19:59 2019 wav


• ...deep, the lens _____ posterior very difficult access....
+ wav
Mon Aug 19 15:37:33 2019 wav
The eye was very large, severe high myopia, with difficult access into the anterior chamber and very deep, the lens _____ posterior very difficult access in all respects for the procedure.

• Medication spelled: F-i-a-s-t (patient's spelling) Patient has
+ thanks
Mon Aug 19 09:51:26 2019 thanks
Diabetes, heart disease, neuropathy, heart murmur.
** • Must be Fiasp. Thanks - thanks
Mon Aug 19 09:52:21 2019 thanks


• A *ladder* styled plate was utilized to
+ ok?
Mon Aug 19 08:07:43 2019 ok?
Here, a Le Forte type I fracture was at this point appreciated, spanning from the right of the piriform aperture to the zygomaticomaxillary buttress. Reduction was performed and in an open fashion, at this point in time, plating was required. A _______ styled plate was utilized to repair the fracture component just to the right of the piriform aperture.
** • using this - ty
Mon Aug 19 09:01:18 2019 ty


• He subsequently underwent a right shoulder MRI study which was perform ...
+ mp3
Mon Aug 19 00:26:46 2019 mp3
He subsequently underwent a right shoulder MRI study which was performed on June 12, 2018. A full-thickness rotator cuff tear, amongst other pathoanatomy was diagnosed on the basis of that study. The patient presented to Summit Orthopedics for postoperative checks on June 06, 2018, June 12, 2018, June 25, 2018, and June 19, 2018. Those records describe the patient is doing fairly well with his wound stable and healing. The _____ postoperative pain was referenced. It was decreasing his ___09.28___ upon narcotic pain medications. No x-rays were taken during those visits.
** • The usual postoperative pain was referenced. There was decrease in his reliance upon - billybob
Mon Aug 19 00:34:44 2019 billybob

**** • Thanks a lot. :-) - guy
Mon Aug 19 00:35:13 2019 guy


• There are clinical encounter narratives available for my review from t ...
+ mp3
Mon Aug 19 00:01:28 2019 mp3
There are clinical encounter narratives available for my review from the physical therapy facility as well as from Summit Orthopedics provider, Dr. Daly and his PA and ancillary staff. ______ physical therapy record, the patient was progressing as expected during the initial one or two weeks following the surgery.
** • never mind. Thanks to anyone who tried. - guy
Mon Aug 19 00:26:25 2019 guy


• The procedure was performed at Eagan Surgery Center. I reviewed the o ...
+ mp3
Sun Aug 18 23:57:36 2019 mp3
The procedure was performed at Eagan Surgery Center. I reviewed the operative record and the postsurgical record from that facility. There appeared to be no particular issues; however, a postoperative x-ray was not documented as having been performed. The patient was ultimately discharged and presented for his typical postoperative visits in the hands of Dr. Daly and his staff on multiple occasions. We also began physical therapy very soon after his discharge. There are clinical encounter narratives available for my review from the physical therapy facility as well as from Summit Orthopedics provider, Dr. Daly and his PA and _____ staff.
** • ancillary - poi
Sun Aug 18 23:58:37 2019 poi

**** • Thanks a lot. :-) - guy
Mon Aug 19 00:00:03 2019 guy


• He was ultimately diagnosed with moderately severe osteoarthritis of t ...
+ mp3
Sun Aug 18 23:39:58 2019 mp3
He was ultimately diagnosed with moderately severe osteoarthritis of the left knee which was treated non-surgically which included injections. That conservative nonsurgical treatment continued for a number of years. There is a record of Mr. Hack presenting for treatment in the ______ including back to Summit Orthopedics on December 28, 2017. On that day, Mr. Hack was evaluated by Daniel Peterson, PA-C. The diagnosis 5:11
** • the years that followed. - billybob
Sun Aug 18 23:50:39 2019 billybob

**** • Thanks a lot. :-) - guy
Sun Aug 18 23:57:54 2019 guy

** • years as follows? - poi
Sun Aug 18 23:41:58 2019 poi

**** • Thanks a lot. :-) - guy
Sun Aug 18 23:43:31 2019 guy


• The patient ______ 60-year-old male who has a history of degenerative ...
+ mp3
Sun Aug 18 23:22:07 2019 mp3
The patient ______ 60-year-old male who has a history of degenerative arthrosis in the left knee.
** • never mind. Thanks to anyone who tried. - guy
Sun Aug 18 23:41:19 2019 guy


• Records presented for my review included a carbon letter, medical reco ...
+ mp3
Sun Aug 18 23:12:18 2019 mp3
Records presented for my review included a carbon letter, medical records from Summit Orthopedics, medical records from Eagan Surgery Center, treatment records from PTOSI, medical records from ______ Internal Medicine provider, Taiwo Lawal, MD, ChB, 3:5
** • Allina (googled doctor name) - poi
Sun Aug 18 23:15:16 2019 poi

**** • Thanks a lot. :-) - guy
Sun Aug 18 23:20:03 2019 guy


• POSTOPERATIVE DIAGNOSIS: Squamous cell carcinoma of right temple. ...
+ mp3
Sun Aug 18 21:51:52 2019 mp3
POSTOPERATIVE DIAGNOSIS:
Squamous cell carcinoma of right temple.

TITLE OF OPERATION:
1. Wide excision of right temple squamous cell carcinoma.
2. Full-thickness skin graft from right lower neck.

OPERATIVE FINDINGS: There was an ulcerative lesion in the right temple. Size of excision was 4.5 x 3.5 _____.
** • oval-shaped - what I hear
Sun Aug 18 22:22:59 2019 what I hear

**** • Thanks a lot. :-) - guy
Sun Aug 18 23:12:05 2019 guy


• After informed consent was obtained, the patient was brought into the ...
+ mp3
Sun Aug 18 21:19:35 2019 mp3
After informed consent was obtained, the patient was brought into the operating room and placed on the operating table in the supine position. After induction of general anesthesia, the patient underwent surgical time-out identifying the patient and surgical site. The patients nasal cavity was decongested with Afrin topically. Next, 1% lidocaine with 1:100,000 epinephrine was injected to both sides of the nasal septum. The patients nose was then prepped and draped in the usual manner. First, a hemitransfixion incision was made in the right anterior septum. Perichondrium and periosteum were elevated in the left side of the septum. The bony cartilaginous junction was separated and both sides of septum were elevated. Deviated septal cartilage and then bone were resected. The inferior tunnel was elevated skeletonizing premaxillary crest. The premaxillary crest was ______ and prominent, and this was partially resected with V-chisel and mallet.
** • never mind. Thanks to anyone who tried. - guy
Sun Aug 18 21:52:10 2019 guy


• POSTOPERATIVE DIAGNOSES: 1. Septal deviation with a blockage of ___ ...
+ mp3
Sun Aug 18 20:39:44 2019 mp3
POSTOPERATIVE DIAGNOSES:
1. Septal deviation with a blockage of ______ in the right side.
2. Turbinate hypertrophy.

TITLE OF OPERATION:
1. Septoplasty.
2. Bilateral reduction of inferior turbinates with inferior bipolar cauterization.




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