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Oct 15 04:33
• I saw this delightful gentleman today. He was very happy that _____ a ...
+ mp3
Wed Oct 16 23:08:00 2019 mp3
I saw this delightful gentleman today. He was very happy that _____ and now has time to concentrate on looking after himself a bit more.
** • he had sold his holiday house and - poi
Wed Oct 16 23:23:27 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 23:24:34 2019 guy


• Oncological Diagnosis: T2C, N1 prostate cancer on _____ trial. ...
+ mp3
Wed Oct 16 22:57:59 2019 mp3
Oncological Diagnosis: T2C, N1 prostate cancer on _____ trial.
** • never mind. Thanks to anyone who tried. - guy
Wed Oct 16 23:08:17 2019 guy

**** • ENZARAD trial - k c i c i j
Wed Oct 16 23:09:56 2019 k c i c i j


• I have arranged for his ADT to start as soon as possible and have reco ...
+ mp3
Wed Oct 16 22:25:09 2019 mp3
I have arranged for his ADT to start as soon as possible and have recommended that he have docetaxel upfront to maximise his anti-tumour treatment and survival.

The patient and his wife were of course quite sad to hear this news, but I do think they understand the significance ____ and the severity of the situation.


** • of it all and the - poi
Wed Oct 16 22:30:06 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 22:30:26 2019 guy


• I will see him again in a couple of weeks time and we will make that ...
+ mp3
Wed Oct 16 22:14:16 2019 mp3
I will see him again in a couple of weeks time and we will make that decision with him at that stage. I will keep you informed _____ very good an open discussion.
** • but we have had a very good - poi
Wed Oct 16 22:19:43 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 22:19:52 2019 guy


• If there is evidence of further rises and especially if we can identif ...
+ mp3
Wed Oct 16 21:55:21 2019 mp3
If there is evidence of further rises and especially if we can identify metastatic disease, then I will talk to him about the various systemic treatment options with some of the newer drugs plus or minus, even _____ some clinical trials.
** • inclusion - poi
Wed Oct 16 22:09:54 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 22:14:00 2019 guy


• Oncological Diagnosis: Metastatic prostate cancer, stable PSA on withd ...
+ mp3
Wed Oct 16 21:23:49 2019 mp3
Oncological Diagnosis: Metastatic prostate cancer, stable PSA on withdrawal of _____
** • Casodex - my guess
Wed Oct 16 21:54:05 2019 my guess

**** • Thanks a lot. :-) - guy
Wed Oct 16 21:55:06 2019 guy


• Whilst the patient's s prostate cancer appears to be stable clinically ...
+ mp3
Wed Oct 16 21:10:41 2019 mp3
Whilst the patient's s prostate cancer appears to be stable clinically and _____, he quite reasonably is a bit worried about the fact that he has lost quite a lot of weight recently.
** • biochemically - poi
Wed Oct 16 21:12:01 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 21:13:40 2019 guy


• His two issues at present are firstly of significant reflux and second ...
+ mp3
Wed Oct 16 18:39:24 2019 mp3
His two issues at present are firstly of significant reflux and secondly of essentially slow bowel habits, but when he needs to use his bowels, he really needs to use them. This has been the case since his treatment. There are no red flags in regards either of these situations and I think the reflux is probably related to his treatment and the bowel change probably consequent on the various changes _____ from his therapy
** • variious changes in his diet __________ - mn
Wed Oct 16 19:54:51 2019 mn

**** • Thanks a lot. :-) - guy
Wed Oct 16 20:01:44 2019 guy

** • never mind. Thanks to anyone who tried. - guy
Wed Oct 16 19:45:59 2019 guy


• He did have significant problems in tolerating pazopanib and by the so ...
+ mp3
Wed Oct 16 18:17:53 2019 mp3
He did have significant problems in tolerating pazopanib and by the sound of things, never really got much above 50% of dose. He is on this level with nivolumab. Given the phase 1 data suggesting the two together _____ all the tough on the liver, I think the dose reduction here has probably spared him.
** • never mind. Thanks to anyone who tried. - guy
Wed Oct 16 18:39:06 2019 guy


• He has now been on the combination of pazopanib with introduction of n ...
+ mp3
Wed Oct 16 17:54:29 2019 mp3
He has now been on the combination of pazopanib with introduction of nivolumab. The idea I gather being to try and maintain some control with the _____ because of previous very rapid growth pattern when this agent was stopped _____ waiting for his immunotherapy to kick in.
** • 1. TKI 2. whilst - p0oi
Wed Oct 16 18:15:58 2019 p0oi

**** • Thanks a lot. :-) - guy
Wed Oct 16 18:17:38 2019 guy


• I note his history which is fairly complicated from the orthopaedic/bo ...
+ mp3
Wed Oct 16 17:44:04 2019 mp3
I note his history which is fairly complicated from the orthopaedic/bone point of view because of the ill-located metastasis that finally was operated on in fairly dramatic fashion in May _____ this year. This has given him significant improvement in pain, although function is still _____ somewhat to be desired.
** • #2: Function still leaves somewhat to be desired - k f f a b n
Wed Oct 16 17:54:28 2019 k f f a b n

** • "or so" - k f f a b n
Wed Oct 16 17:53:56 2019 k f f a b n

**** • Thanks a lot. :-) - guy
Wed Oct 16 17:54:15 2019 guy


• Clinic Note
+ l b d f m b
Wed Oct 16 13:14:15 2019 l b d f m b
Severe malnutrition, that is the "PCMNPOST".
** • PCM = protein-calorie malnutrition. NPOST is maybe endpost? or endpoint? - taco
Wed Oct 16 13:22:13 2019 taco

**** • Thanks for the help! - l b d f m b
Wed Oct 16 13:22:51 2019 l b d f m b


• He does not wish an intervening appointment prior to getting the show ...
+ mp3
Wed Oct 16 09:48:14 2019 mp3
He does not wish an intervening appointment prior to getting the show on the road. I have suggested he touch base with his GP to obtain a care plan as the assistance with dieticians, speech pathology, exercise physiology, _____ if all very useful in this regard.
** • and the like. - billybob
Wed Oct 16 09:50:00 2019 billybob

**** • Thanks a lot. :-) - guy
Wed Oct 16 09:50:36 2019 guy


• We walked through the fairly cruel and unusual nature of the treatment ...
+ mp3
Wed Oct 16 09:38:32 2019 mp3
We walked through the fairly cruel and unusual nature of the treatment as well as self-help techniques that he can employ to try and get him through treatment. We have discussed his increased susceptibility to ototoxicity and neurotoxicity given these underlying things. The options therefore run between trying an _____ schedule of cisplatin such as the weekly one, which is less likely to cause these problems or moving to either an inferior drug like carboplatin or an equivalent, but much more difficult _____ like carboplatin/fluorouracil.
** • I suspect it's "alternative" but he's so clear on everything else... + billybob
Wed Oct 16 09:48:55 2019 billybob
I'm trying to read a more literal soundalike into it.
**** • Thanks a lot. :-) - guy
Wed Oct 16 09:50:27 2019 guy

** • #1 alternate #2 regimen - taco
Wed Oct 16 09:46:17 2019 taco

** • ... regimen - billybob
Wed Oct 16 09:45:10 2019 billybob

**** • Thanks a lot everybody - guy
Wed Oct 16 09:47:32 2019 guy


• Currently, he has some minor symptoms related to his biopsy and the ne ...
+ mp3
Wed Oct 16 09:32:46 2019 mp3
Currently, he has some minor symptoms related to his biopsy and the neck lump, but is otherwise quite well. His co-morbidity is well-controlled on irbesartan and metformin. He has no contraindications to cisplatin, but I _____ in the form of some hearing loss in social situations, probably related to his army days and artillery usage.
** • a caution. - billybob
Wed Oct 16 09:37:59 2019 billybob

**** • Thanks a lot. :-) - guy
Wed Oct 16 09:38:18 2019 guy


• I therefore walked him through the treatment situation. He is very ke ...
+ mp3
Wed Oct 16 09:22:22 2019 mp3
I therefore walked him through the treatment situation. He is very keen on a curative approach. By the NRG algorithm, it looks like his chances of cure are approximately 85% with chemoradiotherapy. I therefore contrasted this with radiation alone which would be expected to result in about a 7% to 10% worsened outcome, but obviously with an order of magnitude, less toxicity, _____ . We walked through the fairly cruel and unusual nature of the treatment as well as self-help techniques that he can employ to try and get him through treatment. We have discussed his increased susceptibility to ototoxicity and neurotoxicity given these underlying things. The options therefore run between trying an
** • both in the acute and late setting. - taco
Wed Oct 16 09:24:09 2019 taco

**** • Thanks a lot. :-) - guy
Wed Oct 16 09:28:40 2019 guy


• Just a quick note to say that he is actually doing pretty well. His c ...
+ mp3
Wed Oct 16 09:05:10 2019 mp3
Just a quick note to say that he is actually doing pretty well. His cholesterol has snuck up a little bit which I am not particularly perturbed about as he has decreased his use of statins and this was in the situation of primary prevention _____ to treat is quite substantive. In regards his malignancy for reasons _____ to the creator, the pathology lab has not yet done his PSA. The remainder of his biochemistry is quite satisfactory and he has stable leukopenia dating from the treatment of his lymphoma.
** • where the number needed to treat...for reasons known only to the Creator. - billybob
Wed Oct 16 09:11:39 2019 billybob

**** • Thanks a lot. :-) - guy
Wed Oct 16 09:16:44 2019 guy


• The patient's scans have shown no significant FDG-avidity. Significan ...
+ mp3
Wed Oct 16 08:04:44 2019 mp3
The patient's scans have shown no significant FDG-avidity. Significant increase on her _____ scan in her hepatic disease burden and pulmonary nodularity, but stability of the liver on her conventional imaging. Her chromogranin continues to rise.

I think there is therefore every reason to consider further systemic therapy. To that end, she will be continuing discussions with (physician name/beyond me) about the possibility of further _____. The question _____ as to whether one adds chemotherapy to this.
** • discussions with (Gabby) about the possibility of further Lutate - taco
Wed Oct 16 08:31:15 2019 taco

** • avidity, significant increase on her DOTATATE scan (note comma after "avidity") - taco
Wed Oct 16 08:30:25 2019 taco

** • the question then will arise as to.... - d p c d b k
Wed Oct 16 08:30:17 2019 d p c d b k

**** • Thanks a lot. Thanks for the correction everybody. - guy
Wed Oct 16 08:56:02 2019 guy


• In some instances, a post-viral pericarditis can hang around for up to ...
+ mp3
Wed Oct 16 06:22:21 2019 mp3
In some instances, a post-viral pericarditis can hang around for up to 12 months and still does remain the most likely cause. As it has now been three months and we have _____ control, I think it would be worth a pulse of steroids and I have given her a script for prednisone 50 mg to take for five days. I have told her that she should remain vigilant about gastrointestinal upset. I would recommend that she continue on the colchicine for a period of 12 months. Overall, it has caused issues with her appetite but for the most part, she has been able to tolerate it with the help of some Nexium.
** • not been able to achieve symptom - taco
Wed Oct 16 06:34:10 2019 taco

**** • Thanks a lot. :-) - guy
Wed Oct 16 06:38:54 2019 guy


• The patient also has been experiencing intermittent issues with her mi ...
+ mp3
Wed Oct 16 03:15:36 2019 mp3
The patient also has been experiencing intermittent issues with her middle digit on her left hand which would suddenly appear white. She had a picture of it today and it looks like Raynaud's phenomenon. In view of ongoing issues with pericarditis and new onset of Raynaud's phenomenon, I think it will be worth investigating her for potential inflammatory or autoimmune conditions, given her _____ blood test for ENA, ANA, double-stranded DNA, and ANCA. I should have also put C3 and C4 on this _____ to do this when she comes to see, it would be much appreciated.
** • #1 - form for #2 - and, if you are able to do this when she comes to see you, - taco
Wed Oct 16 06:14:36 2019 taco

**** • Thanks a lot. :-) - guy
Wed Oct 16 06:22:07 2019 guy


• As you are aware, she has had ongoing chest discomfort since her initi ...
+ mp3
Wed Oct 16 03:04:50 2019 mp3
As you are aware, she has had ongoing chest discomfort since her initial diagnosis of pericarditis back in June. She has continued on the colchicine for three months, but had ongoing pain throughout and as you are aware, it was significantly exacerbated during _____.
** • never mind. Thanks to anyone who tried. - guy
Wed Oct 16 03:15:11 2019 guy


• is adopted and is only aware of her biological fathers history. He h ...
+ mp3
Wed Oct 16 02:46:47 2019 mp3
is adopted and is only aware of her biological fathers history. He had congenital heart condition and died from a cardiac cause; however, she was unable to give any further details. She does know her _____ on her fathers side. One of ____ had a stroke and the other has diabetes.
** • her aunt from her father's side, one of whom has had a stroke - billybob
Wed Oct 16 02:56:58 2019 billybob

**** • Thanks a lot. :-) - guy
Wed Oct 16 03:04:21 2019 guy


• She has noticed no specific decline in this activity, but on some occa ...
+ mp3
Wed Oct 16 02:24:18 2019 mp3
She has noticed no specific decline in this activity, but on some occasions when she gets to the top, she can be quite _____ with her breathing. She however a couple of weeks ago had shortness of breath from quite minimal exertion, just going from her _____ room to her kitchen.
** • #2 ???bathroom??? - Questyr
Wed Oct 16 02:44:51 2019 Questyr

**** • Thanks a lot. :-) - guy
Wed Oct 16 02:45:09 2019 guy


• I performed an ECG today, which demonstrated sinus rhythm. There was ...
+ mp3
Wed Oct 16 02:02:50 2019 mp3
I performed an ECG today, which demonstrated sinus rhythm. There was a deep S-wave in V2 and _____V4 consistent with possible left ventricular hypertrophy.
** • never mind. Thanks to anyone who tried. - guy
Wed Oct 16 02:10:56 2019 guy


• The valve has deteriorated. It is both stenotic and regurgitant and s ...
+ mp3
Wed Oct 16 01:34:29 2019 mp3
The valve has deteriorated. It is both stenotic and regurgitant and she is significantly symptomatic. She remains keen to have further children and we discussed potential valve replacement options for her, particularly in the context of her having active disease elsewhere. You may recall that consideration was made for possible _____ and she had investigations to this.
** • TAVR - poi
Wed Oct 16 01:36:39 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 01:40:49 2019 guy


• On examination today, she had no overt signs of fluid overload with ch ...
+ mp3
Wed Oct 16 01:14:57 2019 mp3
On examination today, she had no overt signs of fluid overload with chest clear to auscultation and no peripheral oedema. Her blood pressure was 130/70mmHg. The heart sounds were dual with an ejection systolic murmur at the base and early diastolic murmur _____ consistent with aortic stenosis and regurgitation.
** • at the sternal edge? - poi
Wed Oct 16 01:26:59 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 01:33:18 2019 guy


• She has had ongoing issues with chest discomfort and pain down her lef ...
+ mp3
Wed Oct 16 01:03:27 2019 mp3
She has had ongoing issues with chest discomfort and pain down her left arm. She tells me that she also has a productive cough which can at times have bright red sputum. She has noticed in particular that she can get short of breath when she is lying down flat and has to sit up, but for the most part, usually _____ just one pillow.
** • gets by with just the one pillow - poi
Wed Oct 16 01:06:37 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 01:09:00 2019 guy


• The patient's last review with me, his main issue has been to do with ...
+ mp3
Wed Oct 16 00:22:09 2019 mp3
The patient's last review with me, his main issue has been to do with light-headedness, particularly in the night when he is getting up to go to the toilet. I understand he was changed from _____ to Minipress and this made the light-headedness much worse. He has now subsequently stopped both medications and is generally feeling well.
** • tamsulosin - poi
Wed Oct 16 00:44:50 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 00:50:06 2019 guy


• He tells me that in his most recent review with the neurologist, he ha ...
+ mp3
Wed Oct 16 00:15:34 2019 mp3
He tells me that in his most recent review with the neurologist, he has had an MRI which has demonstrated previous mini strokes. In view of this, we should continue to be strict with our cholesterol target. His most recent blood test indicate that his LDL has improved _____ 3.0mmol/L, but ideally we would like it to be less than 1.8mmol/L.
** • and is sitting now at?? - poi
Wed Oct 16 00:21:08 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 00:21:54 2019 guy


• Since the patient's last review, he has increased his dose of _____. ...
+ mp3
Tue Oct 15 23:30:13 2019 mp3
Since the patient's last review, he has increased his dose of _____. Feels that overall he has had less in the way of headaches. At home, his blood pressures have been around
** • Coveram - poi
Wed Oct 16 00:11:32 2019 poi

**** • Thanks a lot. :-) - guy
Wed Oct 16 00:15:08 2019 guy

**** • t - guy
Wed Oct 16 00:15:02 2019 guy


• On examination today, his blood pressure was _____ normal 149/80mmHg w ...
+ mp3
Tue Oct 15 23:06:35 2019 mp3
On examination today, his blood pressure was _____ normal 149/80mmHg with a regular pulse at 90 beats per minute.
** • upper limits of normal - poi
Tue Oct 15 23:07:36 2019 poi

**** • Thanks a lot. :-) - guy
Tue Oct 15 23:11:03 2019 guy


• She has had one fall which was mechanical in nature about 18 months ag ...
+ mp3
Tue Oct 15 21:54:03 2019 mp3
She has had one fall which was mechanical in nature about 18 months ago. She has not noted any significant mood issues. Her sleep pattern is normal. She denied any recent acute health issues or infections treated with antibiotics. She is under cardiology follow up through the _____. The patient was born in Germany and has completed her school education.
** • HOA _____. + guy
Tue Oct 15 21:58:12 2019 guy
HOA name of hospital.
**** • never mind. Thanks to anyone who tried. - guy
Tue Oct 15 21:59:28 2019 guy


• Aged care assessment has been done, but they are not accessing any sup ...
+ mp3
Tue Oct 15 21:16:36 2019 mp3
Aged care assessment has been done, but they are not accessing any supports currently. Her previous medical issues include hypertension, atrial fibrillation, GORD, osteoporosis, COAD/asthma, ischemic heart disease/CHF, depression, osteoarthritis.

His current medications include;
1. Amitriptyline 10 mg nocte.
2. Fentanyl patch 25 mcg/hour every three days.
3. Metoprolol 50 mg bd.
4. Mirtazapine 15 mg nocte.
5. Nexium 20 mg od.
6. Panadol Osteo two tablets twice a day.
7. Ramipril 5 mg od.
8. Ranitidine 150 mg bd.
9. _____ patch.

Daughter reported issues with _____noticeable over last four to five years, getting worse since last three years gradually. This was following the prolonged hospitalisation following right hip fracture.


** • never mind. Thanks to anyone who tried. - guy
Tue Oct 15 21:54:18 2019 guy


• Aged care assessment has been done, but they are not accessing any sup ...
+ mp3
Tue Oct 15 21:13:58 2019 mp3
Aged care assessment has been done, but they are not accessing any supports currently. Her previous medical issues include hypertension, atrial fibrillation, GORD, osteoporosis, COAD/asthma, ischemic heart disease/CHF, depression, osteoarthritis.

His current medications include;
1. Amitriptyline 10 mg nocte.
2. Fentanyl patch 25 mcg/hour every three days.
3. Metoprolol 50 mg bd.
4. Mirtazapine 15 mg nocte.
5. Nexium 20 mg od.
6. Panadol Osteo two tablets twice a day.
7. Ramipril 5 mg od.
8. Ranitidine 150 mg bd.
9. _____ patch.

** • posted above. thanks. - guy
Tue Oct 15 21:16:58 2019 guy


• Their daughter lives in a granny flat on the same property. Husband h ...
+ mp3
Tue Oct 15 20:53:10 2019 mp3
Their daughter lives in a granny flat on the same property. Husband has been her carer for last three years. She is legally blind, needs help with performing PADLs. Husband has been managing most of the domestic chores with help from daughter, who is _____ but is currently on long service leaves. _____ assessment has been done, but they are not accessing any supports currently. Her previous medical issues include hypertension, atrial fibrillation, GORD, osteoporosis, COAD/asthma, ischemic heart disease/CHF, depression, osteoarthritis.
** • leave, not leaves. who is an RA? RN? 2. Aged care assessment - poi
Tue Oct 15 20:59:59 2019 poi

**** • Thanks a lot. Thanks for the correction. - guy
Tue Oct 15 21:03:35 2019 guy


• On cognitive assessment today, he scored 18+1/30, losing most points o ...
+ mp3
Tue Oct 15 18:32:45 2019 mp3
On cognitive assessment today, he scored 18+1/30, losing most points on orientation and executive function including short-term recall. Clock face drawing was appropriate though, but language fluency was limited. He did understand that he requires this assessment for the purpose of ongoing driving license _____ needs. Unfortunately, I do not have any collaterals regarding his driving and he himself was very honest telling me about one speeding ticket and today while taking a U-turn, he hit his car to the curb. There is evidence of moderate cognitive impairment with predominantly Alzheimer's features.
** • I think she corrected license to licensure - poi
Tue Oct 15 19:58:15 2019 poi

**** • Thanks a lot. :-) - guy
Tue Oct 15 20:01:27 2019 guy


• _____ with usual domestic chores, visiting his wife almost every day i ...
+ mp3
Tue Oct 15 18:03:25 2019 mp3
_____ with usual domestic chores, visiting his wife almost every day in the residential care, and making fishing equipments which he gives free of cost to local children.

clipped wav
** • never mind. Thanks to anyone who tried. - guy
Tue Oct 15 18:20:43 2019 guy


• should i put comma before alone?
+ guy
Tue Oct 15 17:53:54 2019 guy
As you are aware, that he lives in his own home, alone.

• He takes his inhalers as required, but no regular medications. On dir ...
+ mp3
Tue Oct 15 17:47:26 2019 mp3
He takes his inhalers as required, but no regular medications. On direct questioning regarding his memory issues, the patient agreed that he may have minor issues with his memory, but he is associating that with normal process of aging and _____ around. He did mention through that you have brought it up with him and mentioned about his declining memory, but he also reported that his daughter has not mentioned anything regarding his memory getting weaker.
** • never mind. Thanks to anyone who tried. - guy
Tue Oct 15 18:03:46 2019 guy


• He is driving currently and denied any recent _____. He is managing h ...
+ mp3
Tue Oct 15 17:34:27 2019 mp3
He is driving currently and denied any recent _____. He is managing his own finances/bill _____ banking, and according to him all his legal paperwork requirements are in place.
** • #1 mishaps. #2 bill paying, banking - sea
Tue Oct 15 17:38:54 2019 sea

**** • Thanks a lot. :-) - guy
Tue Oct 15 17:39:08 2019 guy


• pe. S/L CSM is intact.
+ sm
Tue Oct 15 16:07:17 2019 sm
There is no stability on talar tilt or anterior drawer stress testing referable to the right ankle. s/l CSM is intact.
** • Could it be instability (instead of stability)? - Maybe?
Tue Oct 15 16:54:52 2019 Maybe?

** • CSM = Circulation, Sensation and Movement - taco
Tue Oct 15 16:51:58 2019 taco

**** • thank you- CSM - op
Tue Oct 15 16:53:11 2019 op

** • ? CFL (calcaneofibular ligament) + sm
Tue Oct 15 16:46:24 2019 sm
also, listen for "instability"

• We can plan to do these in a s/l*multi natzi**phase or one stage, if possible
+ sm
Tue Oct 15 14:22:38 2019 sm
He was referred for extraction of multiple teeth including grossly carious #2, #3, root tip #13, and #32. He wishes to have these extracted under local anesthesia. We can plan to do these in a s/l*multi natzi**phase or one stage, if possible
** • ? in the osseointegration phase? - nm
Tue Oct 15 16:40:09 2019 nm


• The reason for the relatively urgent referral is that over the last co ...
+ mp3
Tue Oct 15 02:18:27 2019 mp3
The reason for the relatively urgent referral is that over the last couple of months, the patient has developed a mass on the right side of his nose. I organised CT of facial bones _____ by Jones & Partners on the 11th of October. This shows a lesion suggestive of a chondral tumour of some sort.
** • never mind. Thanks to anyone who tried. - guy
Tue Oct 15 02:23:34 2019 guy


• Oncological Diagnosis: Metastatic prostate cancer, early resistance to ...
+ mp3
Tue Oct 15 02:00:37 2019 mp3
Oncological Diagnosis: Metastatic prostate cancer, early resistance to enzalutamide. Current problem is a two-month history of nasal mass _____ chondroma for further investigations, associated left frontal sinus structure of uncertain significance
** • never mind. Thanks to anyone who tried. - guy
Tue Oct 15 02:18:11 2019 guy


• Oncological Diagnosis: Recurrent transitional cell cancer of the left ...
+ mp3
Tue Oct 15 01:35:12 2019 mp3
Oncological Diagnosis: Recurrent transitional cell cancer of the left renal pelvis, MSI mutation detected suggestive of Lynch syndrome, review on the familial genetics cancer service.

I am delighted to see that he is doing so well on the study drug, CS1003, an immunological agent with predicted high activity in this _____ MSI tumour.
** • Could he be saying "sort of" ...I note it is an MSI mutation - Questyr
Tue Oct 15 01:39:01 2019 Questyr

**** • Thanks a lot. :-) - guy
Tue Oct 15 01:40:22 2019 guy


• I therefore think that the next best option is for her to touch base w ...
+ mp3
Mon Oct 14 23:51:35 2019 mp3
I therefore think that the next best option is for her to touch base with John to see whether a short course of radiation might prove haemostatic. We have also discussed the options in case she has a substantive bleed. If she continues to have low-volume bleeds that are troubling, then the risk and benefit of tranexamic acid must be considered. This is usually quite good at stopping this kind of minor bleeding, but clearly predisposes to thromboembolism in patients who are already _____ predisposed.
** • so - what I hear
Tue Oct 15 00:07:16 2019 what I hear

**** • Thanks a lot. :-) - guy
Tue Oct 15 00:23:05 2019 guy


• Oncological Diagnosis: T4B, N1A, M0 BRAF? melanoma (stage 3C); _____. ...
+ mp3
Mon Oct 14 23:13:47 2019 mp3
Oncological Diagnosis: T4B, N1A, M0 BRAF? melanoma (stage 3C); _____.
** • S/PWLESNB - what i hear - poi
Mon Oct 14 23:25:26 2019 what i hear - poi

**** • Thanks a lot. :-) - guy
Mon Oct 14 23:27:52 2019 guy


• I have given him some reading material. He will mull things over whil ...
+ mp3
Mon Oct 14 23:06:59 2019 mp3
I have given him some reading material. He will mull things over whilst we wait for the BRAF to come out the _____. We will meet in two weeks time for further discussion.
** • cooker - what i hear - poi
Mon Oct 14 23:13:20 2019 what i hear - poi

**** • Thanks a lot. :-) - guy
Mon Oct 14 23:13:32 2019 guy


• He has no contraindications to proposing adjuvant therapy and a discus ...
+ mp3
Mon Oct 14 22:53:00 2019 mp3
He has no contraindications to proposing adjuvant therapy and a discussion therefore has been down these lines. We have discussed the potential advantages which at present are relapse-free survival and distant metastasis-free survival as overall survival figures _____. It is however likely that they will provide a survival benefit given the current trends. Against this is the option of observation
** • clipped, can't get it - poi
Mon Oct 14 23:04:44 2019 poi

**** • Thanks for the effort. - guy
Mon Oct 14 23:06:47 2019 guy


• The patient has the tricky proposition of a nasty primary melanoma wit ...
+ mp3
Mon Oct 14 22:40:38 2019 mp3
The patient has the tricky proposition of a nasty primary melanoma with a small, but real, deposit in the sentinel node making hm at substantive risk of failure; by my calculations, this is looking like about 60% over five years and more of a _____. He has no contraindications
** • note typo hm instead of him - fwiw-poi
Mon Oct 14 22:52:45 2019 fwiw-poi

**** • Thanks for the correction. - guy
Mon Oct 14 22:53:31 2019 guy

** • and move over 15. - poi
Mon Oct 14 22:51:57 2019 poi

**** • Thanks a lot. :-) - guy
Mon Oct 14 22:52:45 2019 guy


• He is pretty keen to get his best chance of cure. Plan is therefore t ...
+ mp3
Mon Oct 14 22:15:05 2019 mp3
He is pretty keen to get his best chance of cure. Plan is therefore to start him with the weekly cisplatin regimen. We will also look to put a _____ gastrostomy in for him in the near future as well.
** • prophylactic - poi
Mon Oct 14 22:17:29 2019 poi

**** • Thanks a lot. :-) - guy
Mon Oct 14 22:18:47 2019 guy


• The patient has had a spell of inpatient rehabilitation and is now hav ...
+ mp3
Mon Oct 14 21:41:08 2019 mp3
The patient has had a spell of inpatient rehabilitation and is now having some rehabilitation at home. His issues are pretty similar with significant mucosal sensitivity and reluctance to eat and drink, and now the issue of postural hypotension. I think that this is related to underlying issues from cisplatin, but almost certainly worsened by his analgesia including recent introduction whilst in rehab of amitriptyline.

I therefore suggest that he stop his amitriptyline. We have reduced his patch and may even be able to _____ back further. We will touch base next week and see how _____ stand.

** • 1. taper this 2. matters - poi
Mon Oct 14 21:49:30 2019 poi

**** • Thanks a lot. :-) - guy
Mon Oct 14 21:50:18 2019 guy

**** • t - guy
Mon Oct 14 21:50:12 2019 guy


• I am still suspicious that he has been having some complex partial sei ...
+ mp3
Mon Oct 14 21:07:59 2019 mp3
I am still suspicious that he has been having some complex partial seizures, but with the introduction of Valproate and steroids, these have significantly improved and his overall mental function he also feels is significantly better. We will therefore increase his Valproate another notch because his serum levels are still low _____ we can perhaps reduce his steroids _____ as these obviously are a double-edged sword.
** • 2. in the future??? - poi
Mon Oct 14 21:14:54 2019 poi

** • 1. but see whether - poi
Mon Oct 14 21:12:50 2019 poi

**** • Thanks a lot - guy
Mon Oct 14 21:16:25 2019 guy


• I am very pleased to say that the patient has improved substantively w ...
+ mp3
Mon Oct 14 21:00:54 2019 mp3
I am very pleased to say that the patient has improved substantively with both steroids and _____.
** • never mind. Thanks to anyone who tried. - guy
Mon Oct 14 21:08:16 2019 guy


• We therefore repeated his imaging which shows some reduction in the si ...
+ mp3
Mon Oct 14 20:48:39 2019 mp3
We therefore repeated his imaging which shows some reduction in the size of the lesion, although as noted in the radiology report, this is not good enough reason for us to forget the matter I therefore put three options to the patient. The first is to monitor with the possibility that this is an untreated malignancy, _____ temporary biopsy with a fair chance that we will end up with the same result, or to ask thoracic surgical colleagues to see him with a view to considering an excisional biopsy.
** • period after matter - poi
Mon Oct 14 20:51:34 2019 poi

** • to attempt re-biopsy - poi
Mon Oct 14 20:50:10 2019 poi

**** • Thanks a lot. Thanks for the correction. - guy
Mon Oct 14 20:52:02 2019 guy


• A note to bring you up-to-date with the patient. His biopsy was ____ ...
+ mp3
Mon Oct 14 20:44:10 2019 mp3
A note to bring you up-to-date with the patient. His biopsy was ____ being a very small sample that showed any normal lung. It clearly was a difficult procedure.
** • showed only normal lung - poi
Mon Oct 14 20:46:00 2019 poi

**** • Thanks for the correction. - guy
Mon Oct 14 20:46:40 2019 guy




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