SUBJECTIVE: This is a patient who is coming in for followup as well as a complaint of a breast nodule. She noted this on the left breast. She denies any pain, denies any drainage. It is on the outer quadrant medially. She also has another complaint, which is her toenail bothers her when she runs. She injured it quite a while ago. The toenail is actually gray on her third middle toe.
From her asthma perspective, she states that it is doing well. She does get some exercise-induced asthma, so we told her to basically use albuterol consistently prior to her exercise. Her Bell’s palsy is continuing to show improvement in terms of eye, in terms of hearing. The patient has mammogram already scheduled for August.
Her past medical history includes Bell’s palsy, asthma, hyperlipidemia, postprandial drowsiness, Gilbert’s syndrome, seasonal allergies.
For review of systems, see history of present illness. The patient feels well otherwise. Breathing is fine. The nodule is not bothering her. The toe does not bother her.
OBJECTIVE: The patient still has some changes on her right side. The eye can be shut down completely, but there are still some differences in terms of comparing to the left side; the eye as well as the mouth. CVS: S1, S2 regular. Lungs: Clear to auscultation. Her toe shows onychomycosis of the great toenail and the third right toe only, but otherwise, the foot looks fine. The skin itself is normal. On her breast exam, right breast is normal, nontender. Left breast: On the medial upper quadrant, basically really on the outer part of her breast, there is a very small nodule. It is almost like pinpoint and it feels frankly more like a soft tissue subcutaneous nodule as opposed to a breast nodule; otherwise, it is nontender. No other masses on palpation. Skin itself is fine. Lymphatic is fine.
ASSESSMENT AND PLAN:
1. Left breast nodule: We will make her do a left breast ultrasound as well as a left diagnostic mammogram. Our suspicion is the test is going to be negative and then we will just monitor. If that is abnormal, we will send her to see a surgeon. For us, it feels more like a subcutaneous nodule.
2. Bell’s palsy: Improving.
3. Onychomycosis: Soaking in vinegar, and we recommended she does not run but walk for her exercise.
4. Asthma: Doing well. She does have exercise-induced component.
We will see her back in the office in 3 months to make sure her breast nodule is properly monitored and evaluated. She will call if she needs anything in between.
