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  "text": "Next patient is [PERSON_NAME] [PERSON_NAME]. [PERSON_NAME]. Medical record number is [HEALTHCARE_NUMBER]. Okay, so go ahead and then tell me what's been going on. So my [OCCUPATION] always tells me that my tonsils are really big. I need to get them looked at. So I'm finally following through with that. Okay. But when I was younger, this was always an issue. My mom took me to all sorts of [OCCUPATION], saw [OCCUPATION] before. I've always had, like, trouble breathing through my nose as well. Okay. And one [OCCUPATION] that I saw when I was, like, [PERSON_AGE] maybe, I vaguely remember this. He said I should have my toxins and my [MEDICAL_PROCESS] [MEDICAL_PROCESS]. My mom didn't want to do it for whatever reason. I don't know why. And we kind of just forgot about it. And I've been dealing with it forever. Okay. I snore really loud. My [MARITAL_STATUS] says it sounds like I don't breathe well while I'm sleeping. Like, stopping our pauses and breathing. Yeah, like, short little pauses. I think it's definitely worse when I'm on my back because of the tonsils. Okay. How about, like, the quality of your sleep? Like, when you wake up in the morning, do you feel refreshed by sleep at all? Not really, but I don't have anything to compare it to. Okay. Yeah. Because it's been like this forever. Okay. How about your daytime, like, alertness level, daytime energy level? Do you feel, like, wiped out during the day or really tired or tired at all during the day? Not really. Okay. Not abnormally, at least. Okay. Any difficulties with swallowing at all the tonsils? Okay, how about [MEDICAL_CONDITION] [MEDICAL_CONDITION]? None that I've been aware of. And how about [MEDICAL_CONDITION] [MEDICAL_CONDITION]? They're like these little particles that come out of the tonsils. They're, like, white. They stink. They look like little rocks. Like, they look like nerds almost. I don't think I've had that. Okay. Yeah, you'd know. It's okay. Yeah. Most people are like, oh, God, yeah, I got those. And then your nasal breathing. So that's been something going on for a long time, too. Yeah, forever. And what have you tried for it so far? Any sprays? Like, have you [DRUG] rinse or. What is that thing? I don't know. I think [DRUG] sprays and all sorts of things. Things flonase. Nothing really seems to make a difference, though. Okay. And is one side worse than the other at all that you notice? I don't think so. Okay. Is it ever normal or you feel like, wow, this is really clear, even for, like, a second. Not very often. But last summer I stopped. I was like, on this vegan diet for like [DURATION] [DURATION]. So I wasn't eating any dairy. And I feel like that may have made an improvement. Okay. We were walking outside one day and I don't know, I stopped and I realized that I could breathe really well through my nose. It seemed correlated with diet. Okay. But I'm not sure. All right. And then. Anything else that you want to mention? Otherwise you think of. Okay, we'll have a seat here. Pause this maybe. Next section is [MEDICAL_PROCESS] [MEDICAL_PROCESS]. [MEDICAL_PROCESS] [MEDICAL_PROCESS]. The inferior turbinates are enlarged, period. There's a somewhat wide nasal septal crest, period. The nasal cavities themselves are fairly narrow, period. On [MEDICAL_PROCESS] [MEDICAL_PROCESS], the tonsils are two to three plus in size and bulky. The remainder of the exam is normal. Next paragraph. Number one is [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Number two is nasal obstruction. Number three is [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_CONDITION]. Number four is [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Next paragraph. The patient reports a long history of large tonsils as well as difficulty breathing through the nose, period. With respect to the tonsils, comma, they are two to three plus in size and quite bulky, period. I do not suspect [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] based on the history, comma, but do think that the tonsillar enlargement is a likely contributor to loud snoring and could have some negative impact on his sleep quality in general, period. Next paragraph. With respect to nasal airflow, comma, this has been a chronic problem for which the patient has used [DRUG] [DRUG] and [DRUG] [DRUG] in the past, period. [MEDICAL_PROCESS] [MEDICAL_PROCESS] demonstrates a narrow nasal vault, comma. Although the inferior turbinates are prominent enlarged, period. The septal crest is also somewhat wide, period. It is entirely likely that shrinking the turbinates could result in a significant improvement in nasal airflow, period. Next paragraph. Plan I discussed my assessment as above with the patient. Next line. I discussed potential management options for nasal obstruction, including [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] via [MEDICAL_PROCESS], period. I discussed that I estimate a [STATISTICS] chance this would improve his nasal airflow, period. However, I did discuss that there is a septal contribution to his nasal obstruction, comma, as well as a contribution from the nasal or narrow nasal airway to begin with, period. With respect to the large tonsils, comma, I did discuss procedural management involving [MEDICAL_PROCESS], period. I discussed the risks of both procedures with the patient, comma, answered his questions to a state of satisfaction, comma, and described the procedures, period. The patient would likely correction the patient is definitely interested in pursuing [MEDICAL_PROCESS] and will likely call us to schedule a period. [MEDICAL_PROCESS] would be scheduled as an outpatient under [DRUG] [DRUG] with a [DURATION] [DURATION] procedure time period. End of patient. Thanks.",
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