Lisa is a 43-year-old female here today with complaints of a cough.
The patient tells me she told the friend her friend Tess that she had a cough in order to get in the door. She says she just really wants to talk about getting a low dose CT scan. The patient tells me she has been a smoker since the age of 12 and she smoked on and off. Over the years, she has been on multiple trials of Chantix, more recently has been using it again for the last five days. She has been prescribed this through her PA at her work. She is the medical assistant at another practice. She has had success with the Chantix and when she is taking it, she does not smoke, but when she stops the Chantix, she starts again. She says that for the most part, she…show more content… She has a dry cough at times. She does feel short of breath sometimes. She does not have a productive cough. There is no hemoptysis. There is no discoloration to the mucous. She has no history of asthma or other lung disease. She has had pulmonary function testing, she reports years in the past, but has not had that done so recently. When I first met the patient, she told me that she was a nonsmoker and had never smoked in the past. It was only recently that I learned of her tobacco use. She reports that she is not having any fevers, chills, or night sweats. There has been no weight loss without trying. In fact, since I first met the patient, she has gained 34 pounds. She is wondering whether she should get a low dose CT scan. She is not having any cold symptoms. She is not having any allergy symptoms that she is identified and she knows if…show more content… A/P
Lisa Soucie is a 43-year-old female here today for followup
• Cough. We did discuss the differential diagnosis of this and I reviewed reviewed with her routine low dose CT screening guidelines. After discussion of the options, I elected to write for a PA and lateral chest x-ray. She does understand that this may be normal and that does not mean that there is not more pathology going on in the chest. If it shows any abnormalities, then more follow up can come. I told her one of the more important tests may be to do a pulmonary function study, which she declines wanting to do today. She has office spirometry and would like to start with that in her office and then will send me those reports with further recommendations to follow. We had a long and very frank discussion about her smoking and II have encouraged her to stop. I also talked about the Chantix long term, which I would recommend against, based on the information that we have to date and that is something she is going to consider, after she finishes this round of