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  "text": "[PERSON_NAME] [PERSON_NAME] goes by [PERSON_NAME]. Date of birth, [DATE_OF_BIRTH] [DATE_OF_BIRTH], [DATE_OF_BIRTH]. She is a follow up for [MEDICAL_CONDITION]. Her Last visit was [DATE], [DATE], [DATE] when she was continued on [DRUG] daily. Started on [DRUG] for [DURATION] [DURATION] with plan to start [DRUG] [DRUG], [DRUG] [DRUG] if covered by insurance. Continued on [DRUG] [DRUG], [DRUG] [DRUG] [DRUG] and [DRUG] [DRUG] for [MEDICAL_CONDITION] [MEDICAL_CONDITION] of scalp face mirrors. Please pull forward the derm history from the [DATE] [DATE], [DATE], [DATE] note. Hello, [PERSON_NAME]. Hi. Welcome back. How are you? I'm great. How you? Good. This just sits here and helps me write my note later. So we'll just ignore it. And it's been, I can't believe it, [DURATION] [DURATION] [DURATION]. Yeah, time flies. [EVENT] will quoted never end. And we're back to follow up on [MEDICAL_CONDITION] today. [PERSON_NAME]. Yeah. But as long as I'm here, convenient timing. I got a rash on my back. Oh, no. That's kind of affecting my muscle underneath. Started out kind of itchy and then I started putting [DRUG], wall drill type [DRUG] [DRUG] on it just because that's usually what I do for like [INJURY] [INJURY] [MEDICAL_PROCESS] just, you know. And then it got worse. Now I tried [DRUG] and it's like, you know how when you get a [INJURY] in your side. I'm getting that in my back underneath the rash. When did it start? In the last like [DURATION] [DURATION] [DURATION] [DURATION]. Okay. Really recently? Yeah. Okay. Yeah. I'm like, well, it's a good thing I have a drink. Seriously. So we'll take a good look at that. And then how is [MEDICAL_CONDITION] doing? Okay. I have mask knee has come back and it's I think made worse because I'm on some new medication that dries out my skin. Oh, okay. And so once I went on that, it kind of started to get. Which one is that? I don't know. It's one [MEDICAL_CONDITION] [MEDICAL_CONDITION] new ones. [DRUG], [DRUG]. The other one that I'm on, [DRUG] [DRUG]. Okay. Okay. One of those. I remember reading may dry out your skin and it. And I have like dry patches. You've noticed that more. Okay. It's better. I've been trying to drink more water and stuff like that. Okay. But yeah, sounds good. I'm getting a little more like [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Okay. And what all are you still using on the face? My daily routine is cave. So the moisturizing, cleanser and the PM AM lotions and that's pretty much it. Okay. For a daily type of thing, I use the other like [DRUG] [DRUG] and that you prescribed. But you know, by the time I start doing much. Yeah, okay. I think it goes away faster, but it doesn't really prevent it, so obviously so it just keeps. And is it the [DRUG] you're using? Because I know we. Oh, and the [DRUG]. Okay. Yes. Wait, then what's the other one you're using? Is it the new one we prescribed last time, Another prescription [MEDICAL_PROCESS] not? Yeah, it starts with an [DRUG]. Okay. So you don't feel like that's added too much to. No, I don't use that on a daily basis. Oh, you're just using it more as a [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Yeah. Okay. Should I use it on a daily basis? Yeah, probably that might help. So. Okay, perfect. So we'll talk about that and then anything else skin wise, you're worried about? No, I mean, everything else seems to be pretty much under control. I use the shampoo [DURATION] [DURATION] [MEDICAL_PROCESS] [DURATION] [DURATION] and the Clovis dough, you know, couple also. Excellent. And that I haven't had any problems since we started using that, so. Great. Well, let me take a look at you. Okay. Have you sit over here. All right. That pillow is going to be all sorts of in the way, so I'm going to move it over there. I'm going to take a look at your back first. Here. I have no idea what it looks like because I can't see. Started off like I said, it was just like a little itch. Yeah. And then. Yeah, let me grab gloves because you have. But then you also have something on your upper back. Oh, that's stupidity. Oh, no. Okay, well then I actually, I'm much more confident about what this is now. What did you do to your upper back? I had a [MEDICAL_CONDITION] and it made my neck really tight and I have one of those like theragun things and I was so out of it, I didn't realize that, you know, over the shirt and so I had all kinds of chafing things going on and it wasn't until I stopped and I'm like, oh, man, that really hurt. Oh my goodness. So, okay, well, that answers my question. I have a feeling you have [MEDICAL_CONDITION]. I kind of looked that up this morning. It's not. I feel fine. Yeah. Oh, no. And that's good. And I will tell you, it's not sort of come fully out yet, so I'm gonna Take a little [MEDICAL_PROCESS] to confirm. But the reason I was confused about the other spot [MEDICAL_CONDITION] is normally on one side of your body. And this is on your left mid back. And this was on your right upper back. And I was like, this can't be. Yeah. No, I'm just stupid. But it's in a perfect almost rectangle. And then the fact that you're telling me that you have sort of a deeper sensation. Yeah. Is pretty common. I had to put some [DRUG] [DRUG] on this morning just to get through the exam because my back, like I said, like it's. I have a [INJURY] in my side. In my back. Yeah. So typically what we do with that. So I will [MEDICAL_PROCESS] to confirm. That takes about [DURATION] [DURATION] to come back. But I do recommend that we go ahead and get started on treatment. The. The treatment is a [DRUG] called [DRUG] [MEDICAL_PROCESS] [DRUG]. It's super safe. It's something we could potentially stop once the results come back tomorrow if they're negative. But I'm suspicious enough. Is it [MEDICAL_CONDITION]? So we'll talk about that. No, no. Qualify. There is a qualification. Let me look at your face and then I'll explain because otherwise I'll get distracted. Take my mask. Yes. Oh, yeah. You do have a lot of inflamed bumps on your chin. You are definitely a little more dry. You have just a little bit of rash under your. Your chin. Okay. Tell you've been just a little itchy in the ears. Scalp does look fantastic that you're doing a really good job with. I don't see much there at all. Okay, perfect. You can have mask back. And then I just want to look around your side because sometimes it can extend a little bit further. Do you mind slipping this arm out? No, I can take a look at that. And then nothing on breast at all that you've noticed. Okay, sounds good. So you can have that back. So the qualification about being [MEDICAL_CONDITION] is this. So it can be [MEDICAL_CONDITION] by touch to someone who has not either had [MEDICAL_CONDITION] [MEDICAL_CONDITION] yet [MEDICAL_PROCESS] who hasn't basically that. Or who hasn't been [MEDICAL_PROCESS]. And mostly that's babies [PERSON_AGE] [PERSON_AGE] [PERSON_AGE]. Okay. Otherwise, go ahead. So my [MARITAL_STATUS], who's been rubbing the stuff on my back because I can't reach that stuff, is not affected. If he's had [MEDICAL_CONDITION]. If he has had [MEDICAL_CONDITION]. No. I mean, I do. In general, I think it's good to have people avoid touching it now that you know what it Is. But no, your. Your [MEDICAL_CONDITION] comes from your old [MEDICAL_CONDITION] [MEDICAL_CONDITION] coming out. Okay. So the only way you can give it to someone is it's the same [MEDICAL_CONDITION] as [MEDICAL_CONDITION]. So you. Someone who hasn't had [MEDICAL_CONDITION] could get it if they touched the fluid [MEDICAL_CONDITION] [MEDICAL_CONDITION] [INJURY]. Gotcha. So it will technically be [MEDICAL_CONDITION] from that standpoint until they're all [INJURY] [INJURY], which they haven't even started doing yet. So remind me what you do for work. I do advertising research. Okay. Mostly from home [MEDICAL_PROCESS]. Sounds good. In general, we say if you're gonna be out and about with people, it's good to just keep it covered. That way you just have sort of an extra layer of protection. So it's kind of hard not to cover. You are very right. Especially I haven't been wearing a bra since this happened. I can't imagine that. I know. Yes. Oh. What was my other caveat? Oh, [MEDICAL_CONDITION] women avoid [MEDICAL_CONDITION] women too. In general. They're also okay if they've had [MEDICAL_CONDITION], but it's just sort of a like ventilator kind of thing. So the treatment is [DURATION] [DURATION] of this [DRUG] [DRUG]. It's [MEDICAL_PROCESS] [MEDICAL_PROCESS] [DRUG] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [DURATION] [DURATION]. It isn't gonna make it go away immediately. A lot of what's come out already is just gonna be there. But it should help keep it from getting worse and hopefully help it go away faster. The pain aspect of things is a totally different story. The [DRUG] doesn't usually help a ton with that, except it can reduce the risk of you getting pain that lasts after the rash goes. You have to sort of let me know how things are. Because what I typically say is if you aren't already taking scheduled [DRUG] and even [DRUG]. Perfect. Then the next step, if that's not cutting it, is usually to add a little bit of a [DRUG] [DRUG] called [DRUG]. [DRUG] is a little bit tricky because it's not one that you just take as needed. You do have to get started on it. And then once you're on it, we have to kind of taper off again, which is fine. It can reduce the risk of this turning into a more long term pain, which sometimes happens, but usually only to older people. So it's which I like that. I am not. You are not. You're correct. I'm glad you got that. You are not in that. So it's, you know, for most people, the pain is going to get better as the rash Goes away. But if it's something where you're like, this is really interfering with my. My daily life, then we could talk. I mean, we could do the [DRUG], and I can talk you through how to do it. You'll probably only be on it for [DURATION] [DURATION] [DURATION] and then stop. It's just not something where you, like, take it one day and not the next. Right. It's gonna kind of build up. It does, yeah. Yeah. So what are your thoughts? Well, how long does it. The pain usually last? Normally, maybe [DURATION] [DURATION] [DURATION]. Yeah. Yeah. All right, well, we'll wait. Okay. You know, let me know. Yeah, you can. We'll definitely start the treatment. Yes. Oh, of course. Yeah. But not the [DRUG]. Yeah. If it. If it doesn't seem to. I just started using the [DRUG] stuff and that. Yeah. Helping. Yeah. So as long as it doesn't interfere with the other stuff. Well, not as far as I know, anyway. I can't think of a way it would. So I'll try that and see if that'll get me through till it goes away. And obviously, if it doesn't go away. Yeah. Or if it's just. You could just my chart me over the next few [DURATION] and let me know. And it's something. We could easily start over my chart, if you want. The main side effects [MEDICAL_CONDITION] [MEDICAL_CONDITION] [DRUG] are drowsiness. That's sort [MEDICAL_CONDITION] [MEDICAL_CONDITION] biggest one. We'll usually start a [MEDICAL_PROCESS] [MEDICAL_PROCESS], but then over the. Over those [DURATION] [DURATION] [DURATION], we'll often add, like, a second [MEDICAL_PROCESS] third [MEDICAL_PROCESS] during the day, and we kind of just ramp it up over [DURATION] [DURATION] [MEDICAL_PROCESS] so. That's the nerve one. The nerve one, exactly. So if. If that's the direction you want to go, you know, just let me know, like, if you feel like things are getting worse over the next couple [DURATION], you might just want to. But you let me know. It's. It's very much up to you. And hopefully things will get better on their own because I just started getting used to my new medication, so it's hard. Any side effects with the [MEDICAL_CONDITION]? Mas? Really not. No. Most people do great with it, so it's just a giant [DRUG], but that's it. All right. So [MEDICAL_PROCESS] [DRUG] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [DURATION] [DURATION] for [DURATION] [DURATION]. Let's see. That's a [MEDICAL_PROCESS] [MEDICAL_PROCESS] [DRUG]. And then I would go ahead and start that sort of. As soon as you can get it. The sooner it gets started. There used to be this sort of old. I don't want to say old [MARITAL_STATUS] tale. We used to only treat people if they were within the first [DURATION] [DURATION] [DURATION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] breakout because that's when [MEDICAL_PROCESS] is most effective. But in general, the [DRUG] is so safe that it's worth treating at any point, especially if we can get it to go away and avoid any pain afterwards. And how long does it usually take to go away? [DURATION] [DURATION] [DURATION] [DURATION], total, start to finish. Usually from this point, it's gonna. It may look more [INJURY], like [INJURY] [INJURY]. Those [INJURY] [INJURY] then sometimes look kind of bloody, like they're red underneath. I know it's kind of gross. And then after that is when they turn into scabs. Once they're all scabbed, you're not [MEDICAL_CONDITION] anymore. And then the scabs just take, you know, time to heal, just like scabs due. I just have to wait for the [INJURY] [INJURY] to start. Yeah, yeah. Even on medication, Correct? Yeah. They do sometimes continue to come out for [DURATION] [DURATION] [DURATION] even after you start the [DRUG]. So like [DURATION] [DURATION], another [DURATION] [MEDICAL_PROCESS] so. Yeah. I would say things could potentially get a little worse over the next [DURATION] [DURATION] [DURATION] [DURATION], and then they should start getting better. I know. You just let me know my chart me if you need anything. All right. And then I am gonna go grab the little [MEDICAL_PROCESS]. I need to take a little [MEDICAL_PROCESS], so. And you use [ORGANIZATION] [LOCATION] [LOCATION]. Okay, sounds good. And then the other question then is [MEDICAL_CONDITION], because I do agree things are a little bit worse. Again, the [DRUG] [DRUG] actually is also a really good preventative treatment. So if you have it already, I would just start using that. Yep. Also along with the [DRUG]. How often do you use the [DRUG]? [MEDICAL_PROCESS] [DURATION] [DURATION] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [DURATION] [DURATION]. [MEDICAL_PROCESS] [DURATION] [DURATION] [MEDICAL_PROCESS] night. And then I've been using the. It's okay in the morning. Yeah. So just put it on your whole face in the morning. And then my question is, do you feel like you need, like, last time you were flaring from the mask again, and we did [DURATION] [DURATION] [DURATION] of an [DRUG] [DRUG] to calm things down. And that works really well. Yes. Do you feel like you want to do that again for [DURATION] [DURATION] [DURATION] just to calm things down? Yeah. Because usually in the past, I mean, I've been getting. Dealing with this for a while now. When it gets to the point where I'm getting deep ones, that's sort of what you need. It just doesn't go away. Otherwise, let's do another [DURATION] [DURATION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [DRUG] then. And then you could always let me know at that point. I do sometimes go from [MEDICAL_PROCESS] [DURATION] [DURATION] down to like [MEDICAL_PROCESS] [DURATION] [DURATION] and try to taper a little bit. If you're doing great and you just want to stop after [DURATION] [DURATION], I think that's fine too, which is what we've done in the past, so. So I'll send that too. You should be fine to take that along with the [DRUG] [DRUG]. Otherwise, if you just want to wait till after, that's fine too. It's. It's not gonna be a big deal either way, so. Perfect. Let me step out and grab what I need. As far as the little [MEDICAL_PROCESS], usually it's not too terrible, but we do have to sort of [MEDICAL_PROCESS] [DURATION] [DURATION] [DURATION] [MEDICAL_PROCESS]. So it's gonna hurt just a little bit. But we'll. We'll get you taken care of. So I'll be right back. I'll be there. So on the left mid back, she has a dermatomal pink patch studded with several small pink papules. Very subtle vesicles, somewhat clustered. Examined only face, scalp, ears and back. There's also some scaling and erosion within the ears. And then the right upper back there are some [INJURY] [INJURY]. Those are related to an [INJURY] from the massage. Again, we'll do a [MEDICAL_PROCESS] [MEDICAL_PROCESS] from vesicle fluid on the back and then. Sorry. Additional exam for the [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION], including cheeks, nose, labella, and the only other thing we only briefly mentioned in plan, [MEDICAL_CONDITION] [MEDICAL_CONDITION], scalp and ears. Continue [DRUG] [DRUG] shampoo [DURATION] [DURATION] [DURATION] weekly to the scalp. Continue [DRUG] [DRUG] up to 1 stale as needed to the scalp and continue [DRUG], [DRUG] [DRUG] up to bid to ears and face as need.",
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