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  "text": "Next patient is [PERSON_NAME] [PERSON_NAME]. Date of birth is [DATE_OF_BIRTH] [DATE_OF_BIRTH], [DATE_OF_BIRTH]. Okay, well, take me through what's been going on. So I usually get [MEDICAL_CONDITION] [MEDICAL_CONDITION] maybe once or twice a year. This year since, like, [DATE_INTERVAL]. I've been treated three times with [DRUG]. It never seems to get better all the way. So. Yeah, let's put the basics. Okay. And what kind of symptoms do you have with their [MEDICAL_CONDITION]? Pressure, congestion. Like pressure in the face? Yep. And I'm just saying that because it's this thing. Yeah. Oh, pressure in the face, in the ears. Sometimes cough. When I wake up, it's usually a lot of pressure. Like last night, I had a lot on the left, primarily of my [MEDICAL_CONDITION]. And then I usually have this, like, gagging cough as I try to, like, clear it in the morning. Yeah. Okay. How about, like, headaches at all? Do you get frequent headaches? Not frequent, but, like, right now I'm starting to have one. Okay. Trying to see if I can quantify that. Maybe like, once a week or so. Twice a week. How is your sense of smell doing? I think it's okay. Okay. I don't think that has changed too much. And then you mentioned pressure in the ears as well. Do you get, like, popping and clicking, that type of stuff, or. I do sometimes, but I've also gotten ringing, like, alternating or just like a muffled maybe and like a static noise. I don't know how to. I think I know what you're. Yeah, I know. Yeah. Okay. And how about difficulty breathing through the nose? Like. Yeah, that's okay. That can be. Yeah. Challenging to the point where I feel short of breath when doing simple activities like laundry or going up the stairs. Okay. Even position changing sometimes at night. You know, just simple things that normally wouldn't be hard for me to breathe in and out of my nose makes it more difficult. And I just noticed, like, I was having, like, this chest tightness the last time before I started [DRUG], and I just realized, like, I was just working so hard to breathe through my nose. Yeah. I'm just like, okay, like, open your mouth and breathe, you know? I mean, it's, like, simple, but it's just like, I'm not a mouth breather, so it just seems weird to, like, switch that. But it's. Sometimes it's very congested, while other times I'm like, okay, I can breathe a little bit better. Does it correlate with the pressure in your face at all? Like, if you're feeling [MEDICAL_CONDITION] [MEDICAL_CONDITION], does the facial pressure typically get worse right now? Yeah. My Facial pressure is pretty high and I'm having. Yeah. A hard time breathing through my nose. Yeah. Okay. [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] at all. Like mucus dripping in the back [MEDICAL_PROCESS] [MEDICAL_PROCESS] throat. I feel like lately. Yes. Okay. I don't know if it's a long standing problem, you know, longer than before the [DATE_INTERVAL], you know, start of this. But since then. Yeah. I feel like I've had this constant, like. Like coughing and. Yeah. And people have told me on exam, you know, that they are like, oh, yeah, the back of your throat is really red or. Okay, I can tell that. Yeah. And in terms of treatments, what have you done so far, if anything, for treatment of this? The [DRUG]. I'm trying to remember which ones I've been on. [DRUG] was the last one. Okay. That I took, I don't think. We didn't do [DRUG]. I don't think about any [DRUG] at all. So I don't usually do [DRUG] or anything like that because my blood pressure. I've tried [DRUG], [DRUG]. They started another [DRUG] [DRUG] the last time. [DRUG]. Yeah. And those seem to do anything at all? Sometimes, but not where I'm like, wow, I feel relief. Yeah. And do you suspect having [MEDICAL_CONDITION] at all? I could. I guess anything's possible. Yeah. Yeah. Typically. Like how, like, seasonal stuff do you get? Seasonal, like, stuff like itchy, watery running, itchy, runny nose, nose blowing, itchy, watery eyes. Sneezes. Frequent sneezes. That is not typically seasonal type stuff. Yeah, not typically. Okay, then. Any other symptoms at all that you wanted to mention? Otherwise? I can't think of anything. Okay. All right, let's have a seat. Let me pause. This next section is [MEDICAL_PROCESS] [MEDICAL_PROCESS] on [MEDICAL_PROCESS] [MEDICAL_PROCESS]. The septum is spurred to the left, period. The intranasal mucosa is fairly dry with crusted mucus bilaterally. And then the remainder [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] is normal. Next paragraph is assessment. Number one is chronic facial pressure. Number two is oral fullness. Aural number three is [MEDICAL_CONDITION] [MEDICAL_CONDITION]. And number four is [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Open parenthesis. Never tested for [MEDICAL_CONDITION]. Close paren. Next line. The patient has had the above symptoms since [DATE_INTERVAL] [DATE_INTERVAL] [DATE_INTERVAL], period. She has been on three courses of [DRUG] without significant improvement, period. She had [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_CONDITION] performed [DATE] [DATE], [DATE], which showed normal [MEDICAL_CONDITION], period. She has already been on [DRUG] and [DRUG], which only helped a mild amount, period. [DRUG] brings up her blood pressure, period. She does not typically have [MEDICAL_CONDITION] symptoms, period. [MEDICAL_PROCESS] [MEDICAL_PROCESS] is significant for dry nasal mucosa with some mucus crusting [MEDICAL_PROCESS] [MEDICAL_PROCESS] inferior and middle turbinates, bilaterally. Period. Next paragraph Plan number one I reviewed the [MEDICAL_PROCESS] results with the patient and discussed my assessment as above. 2. I recommend [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] for [DURATION] [DURATION] and one refill period. The patient is willing to do this period. Number Next I discuss potential [MEDICAL_PROCESS] [MEDICAL_PROCESS] if medical failure if medicine fails, comma involving [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], period. I estimated a [STATISTICS] [STATISTICS] [STATISTICS] chance this will help her nasal breathing comma and a [STATISTICS] chance this would improve facial pressure, period. The patient will consider this period. Next paragraph is Return to clinic based on progress period. End of patient Thanks.",
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