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KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.

109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Peggy Stewart
DATE OF BIRTH: 06/10/1940
DATE: 12/23/08

HPI: Peggy is in today with nine days worth of diarrhea this stopped just. The patient
denied any fever or chills. There has been no melena or hematochezia. She did have
some cramping, but this is now let off. Denies any trouble with urination. Has been able
to take fluids and some solids. She was at a party where some people had similar type of
symptoms.

PAST MEDICAL AND SURGICAL HISTORY: Reviewed and unchanged.

PRESENT MEDICATIONS: Include levothyroxine 0.1 mg daily, Toprol 25 mg she
takes half of these a day; however she has not over the last several days. This was used
more for “shakiness and blood pressure”. She has been taking all of her Actonel and
methotrexate by her rheumatologist. Is going to get IV Reclast. She also takes calcium
and vitamin D, magnesium, a multivitamin, and also Prevacid.

Since last visit she had EGD and was told she had mild gastritis.

OTHER PHYSICIANS: She has seen Dr. Hills since last visit to this office a
rheumatologist, and Dr. O’Roarke ***137__________.

SOCIAL HISTORY: Unchanged.

PHYSICAL EXAM:
Vital Signs: Weight: 126 pounds. Blood pressure: 160/88. Temperature: 97.6. Pulse:
78 and regular. ENT: TMs clear. Nasal mucosa is slightly dry. Buccal mucosa is
slightly dry. Neck: Supple without lymphadenopathy. CVS: Regular rate and rhythm.
Lungs: Clear to auscultation. Abdomen: Soft, nontender, with active bowel sounds. No
organomegaly or masses. Tenderness is noted. Extremities: Without edema.

IMPRESSION: Resolving gastroenteritis.

PLAN: Fluid replacement with Gatorade. Get back on her Toprol and other medications
as outlined. Has routine followup in this office in two weeks.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Robin Hild
DATE OF BIRTH: 10/17/1955
DATE: 12/23/08

HPI: Robin is in today concerning her right leg. The patient states she fell ***240____
over Thanksgiving. She is still having some pain along her anterior right knee. The
patient states she has been having some falls. She states her hips seem to give in. The
patient denies any significant weakness of her lower extremities. She denies any change
in bowel movements or urination. She denies other joint problems. The patient is seen
by multiple other physicians including Dr. Vera for her GI problems and Crohn’s disease,
Dr. Mouzan for anxiety and depression, Dr. Van Hal for lichen sclerosis of her vaginal
area, Dr. Patel for chronic pain, and Dr. Rao for food allergy drops.

PAST MEDICAL AND SURGICAL HISTORY: Reviewed and is outlined.

PRESENT MEDICATIONS: Include Nexium 40 mg one daily, atenolol 25 mg one
daily, Lomotil t.i.d., Pentasa 500 mg four tablets b.i.d., Lexapro 20 mg one-half daily,
diazepam 10 mg b.i.d., trazodone 150 mg at h.s., oxycodone 5 mg t.i.d., testosterone
cream and Esterase vaginally, Astelin nasal spray, Zanaflex 4 mg one to two t.i.d. and
either Allegra or Zyrtec for allergies.

PHYSICAL EXAM:
Vital Signs: Weight: 175 pounds. Blood pressure: 126/76. Pulse: 76 and regular.
Focussing the lower extremities the hips show good range of motion as do the knees and
ankles. There seems to be increased inversion of _____***442 of the ankles bilaterally.
Peripheral pulses are intact. Deep tendon reflexes 2/4 patella and Achilles. Extensor
hallucis longus is intact. The patient had tenderness to palpation over the greater
trochanteric region bilaterally and also over the tibial plateaus bilaterally and down to the
tibial shafts. She has negative meniscus or ligamentous signs of the knees bilaterally.
There is no gross effusion or swelling noted of the knees. There is no crepitance noted.
She does have hamstring tightness noted more on the right than on the left and quadriceps
tightness noted along the left and on the right.

IMPRESSION:
• Right leg pain with fall now approximately four weeks ago. We will obtain x-
ray of her right knee and tibia as the patient has been on steroids for her Crohn’s
disease and also is known osteopenic.
• Muscle imbalance with quads and hamstrings. Exercise sheets given and
explained extensively today.
• Hypertension well controlled.
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Robin Hild
DATE OF BIRTH: 10/17/1955
DATE: 12/23/08

• Crohn’s disease working with Dr. Vera.
• Chronic pain mostly neck secondary to prior auto accidents working with Dr.
Patel.
• Anxiety and depression working with Dr. Mouzan. We discussed today further
workup concerning this and concerning that she is having falls. Dr. Patel has
mentioned perhaps seeing a neurologist. The patient declines this at this time.
We will try an exercise program and see if this is helpful but certainly if she
continues falling then neurological and/or orthopedic workup should be
considered. I have discussed this with the patient today. Of note, she will be
coming back here in a couple of weeks concerning her allergies. I have
recommended six week followup concerning her legs. She is to call in two days
for the results of her x-rays.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Dr. James Jacques
DATE OF BIRTH: 11/11/1941
DATE: 12/23/08

HPI: This is a 67-year-old retired physician from Ohio here concerning follow up on his
thyroid problems and B12 neuropathy. The patient states he has been doing well. He
states his fatigue has resolved since being on Synthroid. His hair situation is
approximately same. He states otherwise he feels healthy.

REVIEW OF SYSTEMS: HEENT: The patient takes occasional Benadryl at nighttime
for nasal congestion but otherwise is unremarkable. CVS: Denies any chest pain, chest
pressure, lightheaded, dizziness, or palpitations. Pulmonary: Denies cough, hemoptysis,
or sputum production. GI: Appetite is good. He denies nausea, vomiting, constipation,
diarrhea, or abdominal pain. GU: Urination is without dysuria, hematuria, or polyuria.
He is having some trouble with some ED and would like to try an ED medication.
Musculoskeletal: After yard working he has occasional low back discomfort but wishes
no workup concerning this at this time. Neuro/psych: Otherwise is negative. The patient
she states she is very active in the community with retirement groups. He is very
interested in history of the area and is in a woodworking group.

PAST MEDICAL AND SURGICAL HISTORY: Reviewed and unchanged.

PRESENT MEDICATIONS: Include Synthroid 0.075 mg per day, Foltek, vitamin one
daily, aspirin 81 mg one every other day, and multivitamin.

PHYSICAL EXAM:
Vital Signs: Weight: 181.5 pounds. Blood pressure: 110/60. Pulse: 84 and regular.
ENT: TMs are clear. Nasal mucosa is moist. Dentition appear in good repair. Neck:
Supple. Thyroid nonhypertrophied and without nodules. Lymph stations are negative.
CVS: Regular rate and rhythm at 76. No S3, S4, or murmurs. Lungs: Clear to
auscultation. Abdomen: Soft, nontender, with active bowel sounds. No organomegaly
or masses are noted. Back Examination: Shows no tenderness to percussion noted in the
spinous processes. No muscle spasm is appreciated. GU: Penis is circumcised.
Testicles are distended. No inguinal hernias are noted. Rectal Examination: No external
lesions. Prostate is 1 to 2/4 and smooth without nodules. Extremities: Without edema.
Skin: Slightly dry and there are no suspicious nevi are noted.

LABS WORK: The patient did not get the lab work previously recommended. She has
lab slip and will have this done today.
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Dr. James Jacques
DATE OF BIRTH: 11/11/1941
DATE: 12/23/08

IMPRESSION/PLAN:
• Hypothyroidism secondary to sick thyroid syndrome. Check levels today.
• History of paresthesias with resolved neuropathy secondary to low B12.
Recheck levels.
• Erectile dysfunction. Sample card of Levitra 20 mg given and explained. Side
effects and realistic expectations explained. The patient is to call for the results
of his lab work next week. Otherwise would recommend follow up in six
months. Further recommendations will be made at that time.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Jewel Addis
DATE OF BIRTH: 12/27/1927
DATE: 12/23/08

HPI: Jewel is in today with her husband. She states she has had a slight cough. Denies
earache, runny nose, or sore throat. No fever or chills. Appetite has been good. No
trouble with bowel movements or urination. She also states that she has had a tremor.
She saw Dr. Baxley for this in October and was given mag oxide 84 mg half b.i.d. Saw
Leroy Snead last week who stopped her Zoloft. The patient states she feels better since
being off the Zoloft. She attributes a lot of her problems to anxiety. She is on Ativan
t.i.d. over the last week and feels that she is feeling somewhat better concerning this. She
states her husband has been ill and has a daughter that also has been ill.

PAST MEDICAL AND SURGICAL HISTORY: Reviewed and basically unchanged.

PRESENT MEDICATIONS: Lipitor 10 mg daily, Ativan 1 mg t.i.d., Folbee one daily,
omeprazole 20 mg one daily, mag tablets SR 84 mg one-half b.i.d., Amitiza 24 mcg p.r.n.
for the constipation and Levoxyl 0.075 mg one daily.

PHYSICAL EXAM:
Vital Signs: Weight: 122 pounds which appears fairly stable. Blood pressure: 138/74 in
the left arm. Temp: 97.3. ENT: TMs are clear. Nose shows some mild rhinorrhea.
Posterior pharynx is noninjected. Neck: Supple. Carotid upstrokes are brisk. Thyroid
appeared nonhypertrophied. CVS: Regular rate and rhythm with an occasional extra
beat. Lungs: Clear to auscultation. Abdomen: Protuberant, soft, and nontender.
Extremities: Without edema.

LABS WORK: Labs drawn last week showed a CBC within normal limits as was the
BMP. Calcium was 10.2 normal is 8.5 to 10.1, magnesium 2. TSH within normal limits.

IMPRESSION/PLAN:
• URI. Conservative treatment, fluids.
• Essential tremor, stable. Of note Dr. Baxley wanted to recheck in three months
and reminded the patient of this.
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Jewel Addis
DATE OF BIRTH: 12/27/1927
DATE: 12/23/08

• Anxiety. Continue the Ativan 1 mg t.i.d. Recommended follow up in one
month to see how she is doing with this and further recommendations can be
made at that time. I will keep her off the Zoloft at this time.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Charles Addis
DATE OF BIRTH: 09/04/1924
DATE: 12/23/08

HPI: Charles is in today with two weeks’ worth of cough. The patient denies earache,
runny nose, or sore throat. The patient states initially the sputum was yellow, but now he
states it is brownish and even reddish color. He states his weight has been stable. His
appetite has been down, but he is taking fluids. He is asking for renewal on Darvocet N
100. He was prescribed this originally by Dr. Schmidt for his arthritis. He has been
taking Tylenol Arthritis two b.i.d.

PAST MEDICAL AND SURGICAL HISTORY: Reviewed and is outlined.

PRESENT MEDICATIONS: Include the Tylenol Arthritis two b.i.d., Aricept 5 mg h.s.,
lisinopril 10 mg daily, levothyroxine 0.175 mg one daily, isosorbide mononitrate 30 mg
one daily, Lipitor 10 mg daily, Avodart 0.5 mg daily.

PHYSICAL EXAM:
General: The patient is pleasant and cooperative. Vital Signs: Weight: 138 down 9
pounds since 10/21/08. Blood pressure: 90/60 on the right. Temperature: 98. ENT:
TMs clear. Nasal mucosa is moist. Dentures are in place. No oral lesions are noted.
Neck: Appeared supple. Carotid upstrokes appeared equal. CVS: Regular rate and
rhythm without S3 or S4. Lungs: Showed some very faint crackles in the bases
bilaterally. Abdomen: Soft and nontender. Extremities: Without edema.

IMPRESSION:
• Suspect bibasilar pneumonia.
• DJD multisite.
• History of coronary artery disease and hyperlipidemia.
• BPH.

PLAN: Chest x-ray today. Start on Levaquin 750 mg one daily #10. Increase the fluids.
Recheck on Monday and certainly if he feels worse prior to that time to go to the local
emergency room or to the Urgent Care next door. Prescription was given for the
Darvocet N 100 may use one q. 6h p.r.n. arthritis pain, but aware cannot take this along
with the Tylenol Arthritis.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: George Lee
DATE OF BIRTH: 03/08/1941
DATE: 12/23/08

HPI: George is in today follow up of his diabetes and hyperlipidemia. The patient states
he went to an ophthalmologist’s office in Clemson but walked down after an hour of and
half wait. He states he will make another appointment. He states he has been having
some diarrhea with some metformin 850 mg b.i.d. He denies any melena or
hematochezia. He states his appetite has been good.

PAST MEDICAL AND SURGICAL HISTORY: Otherwise are unchanged.

PRESENT MEDICATIONS: Include his AndroGel three pumps per day, Hyzaar 100/25
one daily, aspirin 81 mg per day, Viagra 100 mg one-half to one prior to intercourse, and
metformin 850 mg b.i.d.

PHYSICAL EXAM:
Vital Signs: Weight: 201 down 2 pounds. Blood pressure: 112/84. Pulse: 68 and
regular. ENT: TMs clear. Nasal mucosa is moist. No oral lesions noted. Neck:
Supple. CVS: Regular rate and rhythm. Lungs: Clear to auscultation. Abdomen:
Protuberant, soft, nontender, with active bowel sounds. No organomegaly or masses.
Extremities: Without edema.

LABS WORK: Review of labs showed a normal CBC, sodium 132, potassium 32,
glucose 307, hemoglobin AIc 12.5, cholesterol 228, triglycerides 883, HDL 27, PSA was
1.04, TSH 1.49, normal BNP, C-reactive protein 0.6. Insulin level is 8.21. UA showed
glucose. Pulmonary function tests were within normal limits. Stress testing showed very
poor exercise tolerance and dyspnea on exertion, but no ischemic changes were noted.

IMPRESSION/PLAN:
• Uncontrolled diabetes mellitus. Will try ActoPlus Met 15/850 one b.i.d.,
samples given as the patient has no insurance. Side effects and realistic
expectations explained. The patient aware he may need to start insulin and this
is very likely; however, the patient wants to try medication first.
• Hypertriglyceridemia. Start on Tri-Cor 145 mg one daily. Side effects
explained.
• No insurance. Given information on PPA concerning medication assistance.
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: George Lee
DATE OF BIRTH: 03/08/1941
DATE: 12/23/08

• Dyspnea on exertion with stress test and pulmonary function tests within normal
limits. This is probably related to deconditioning. I had a long discussion
concerning same and starting an exercise program and weight loss program. We
will recheck the patient in two months with labs one week prior and further
recommendations will be made at that time. The patient states he will get
serious concerning his eating habits, exercise and weight loss program etc.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Loretta Broome
DATE OF BIRTH:
DATE: 12/23/08

HPI: Loretta is in today stating over the last week she has had a cold. She initially had
sore throat. She had some Keflex 500 mg at home and has been taking this b.i.d. but
feels this has not been helpful. She states she usually gets IM shot of Rocephin and then
was placed on Levaquin. She denies fever or chills. She states her appetite has been
good. She has been sleeping at night. Since last visit she saw her rheumatologist Dr.
Lawson and going to hold off on putting her on Enbrel until the spring.

PAST MEDICAL AND SURGICAL HISTORY: Reviewed and is unchanged.

MEDICATIONS: Restoril 30 mg at h.s., K-Dur 20 mEq two b.i.d., Lotrel 10/20 daily,
Coreg CR 20 mg daily, Lasix 40 mg p.r.n., Plaquenil 200 mg b.i.d., methoprednisolone 8
mg to 16 mg she will adjust on her own, Prevacid 30 mg daily, Darvocet N 100 q.i.d.
p.r.n.

PHYSICAL EXAM:
Vital Signs: Weight: 162 pounds. Blood pressure: 144/80. Temperature: 98.2. ENT:
TMs are clear. Nasal mucosa is moist. Posterior pharynx is noninjected. Neck: Supple
without lymphadenopathy. CVS: Regular rate and rhythm. Lungs: Perfectly clear to
auscultation without rales, rhonchi, or wheezing. Abdomen: Protuberant and soft.

IMPRESSION: URI.

PLAN: The patient really wanted IM medication but I feel this is not indicated nor do I
feel Levaquin is indicated. I have told her since she started the Keflex we will finish a
course of this by a q.i.d. basis, add a Zithromax Z-Pak. In all probability this is a virus or
she seems to always go on antibiotics because of her other conditions. She is told to
follow up if symptoms persist or worsen.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Melissa Cooper
DATE OF BIRTH: 01/29/1965
DATE: 12/23/08

HPI: Melissa is in follow up visit from her leg pains. Was seen on 12/10/08 for same.
The patient describes her legs as achy or crawling sensation. This is worse with rest. She
can somewhat relieve this with massage or with getting up and moving around.

Lab work had been performed and this is reviewed with the patient today. This was
basically unremarkable with a negative ANA, aldolase at 4.0, rheumatoid factor was 8
which was within normal limits. BMP, sed rate, calcium, uric acid, magnesium levels all
within normal limits. Thyroid function tests and CK level within normal limits. Of note,
CBC and serum iron were not performed and the patient states that she had to take iron
off and on throughout her life. She also states that she has a craving for ice and eats ice
like she is an addict.

PRESENT MEDICATIONS: She stopped the Prozac and went back on Lexapro as the
Prozac made her too anxious. She is now taking Lexapro 10 mg for her chronic anxiety
and panic attacks. She also takes over-the-counter acid suppressants which she states are
really unhelpful. She states the Aciphex has been the most helpful but she does have not
the money to pay for this. She also takes Percocet 3 to 5 tablet which she cuts in one-half
she was taking 6 to 12 tablets per week for chronic headaches. I have reviewed with her
consult from Dr. Ricaulde back in 2007 who wanted to get her off of this because he felt
she had transformed into a chronic headache which was probably analgesic based. I have
discussed process of doing this over a month’s period of time.

PHYSICAL EXAM:
Vital Signs: Weight: 147 pounds. Blood pressure: 122/72. Pulse: 88. ENT: TMs are
clear. Nasal mucosa is moist. Posterior pharynx is noninjected. She does have a small
lymph node noted in her right submandibular area. The patient states this grows up and
down for years. No other cervical or supraclavicular or axillary lymphadenopathy is
palpated. CVS: Regular rate and rhythm. Lungs: Clear to auscultation. Abdomen:
Protuberant, soft, nontender, with active bowel sounds. No organomegaly or masses.
Extremities: Hips, knees, and ankles show good range of motion. Peripheral pulses are
intact. Deep tendon reflexes are intact. There is no muscle weakness noted nor is there a
muscle imbalance is noted.
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Melissa Cooper
DATE OF BIRTH: 01/29/1965
DATE: 12/23/08

IMPRESSION/PLAN:
• Ill defined leg discomfort, this could be restless legs possibly secondary to iron
deficiency. We will get an anemia profile and iron profile and the patient is to
all for results. Small half centimeter slightly raised up skin lesion in her right
lower abdomen. The patient states she has picked this and it bled. I have
recommended removal probably by cryotherapy and we will arrange it with
Kelly McCormick to check this. At that time I can review lab work. I have
given her Mayo Clinic Worksheet concerning restless legs. Further
recommendations can be made at that time.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Martha Rice
DATE OF BIRTH: 04/01/1959
DATE: 12/23/08

HPI: Martha is in today followup on her testing. The patient also feels she might have
some bronchitis. She has been having some cough. She denied any fever or chills or
earaches. Cough is relatively nonproductive. The patient states she never runs fevers
however. The patient also is complaining about depression. She states over the last
couple of weeks she has been crying and not wanting to go out and be around people.
She states she has only had this one other time in her life when her mother passed away.
At that time an emergency physician gave her some Ativan. She has used some Ativan
and states she has felt a little bit better.

PAST MEDICAL AND SURGICAL HISTORY: Reviewed and unchanged.

PRESENT MEDICATIONS: Include her Ambien 10 mg p.r.n. to help with sleep,
Prilosec 20 mg one daily, vitamin D 1000 IUs daily.

PHYSICAL EXAM:
Vital Signs: Weight: 192 pounds. Blood pressure: 122/72. Pulse: 74 and regular.
Temperature was 97.7. General: The patient smells like nicotine. ENT: TMs are clear.
Nose shows mild turbinate congestion. The posterior pharynx shows slight postnasal
drip. Neck: Supple without lymphadenopathy. CVS: Regular rate and rhythm. Lungs:
Showed a few scattered wheezes. No rales, rhonchi, or consolidation are noted.
Abdomen: Protuberant, soft, with slight suprapubic tenderness. Extremities: Without
edema.

LABS: Reports of testing to-date showed a echocardiogram with just mild MR, carotid
ultrasound with left carotid minimal stenosis 10 to 15%. CT of her abdomen and pelvis
showed a small nodular enlargement of the left adrenal gland suggestive of small
adenoma. Otherwise is unremarkable. Pap smear was normal. Repeat urinalysis again
shows a small amount of blood in the urine.

IMPRESSION:
• Persistent microscopic hematuria. We will arrange for consult with Dr.
McAlpine as the patient is a heavy smoker.
• DEXA scan showing osteopenia. Add calcium with the vitamin D and repeat
this in two years. Again, emphasized need for smoking cessation.
• Mild wheeze secondary to her smoking. Samples of ProAir given and explained.
First dosage given in the office. Again stop smoking.
• Anxiety and depression. Prescription for Celexa 20 mg one daily with the
supper given. Side effects and realistic expectations explained. Follow this in
one month. Also discussed with Martha results of her mammogram which
showed a small 1 cm nodule in the central portion of the left breast and need for
followup spot compression ultrasound correlation.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Evelyn King
DATE OF BIRTH: 03/20/1940
DATE: 12/23/08

HPI: The patient is in today complaining of sinus congestion. She was seen 02/11/08
and felt to have pneumonia. Finished a ten-day course with ortho _____***2904
Levaquin. _____ during the first two days she took two pills per day and got ____ sick
with it and skipped a day or two and then finished the medication. She denies any fever,
chills, or sweats. She has mild pressure in her right maxillary sinus. She denies any
nasal discharge.

PAST MEDICAL AND SURGICAL HISTORY: Unchanged since her last visit.

PRESENT MEDICATIONS: Reviewed and is as on her medication list.

PHYSICAL EXAM:
Vital Signs: Temp: 98.1. Weight: 181 pounds. Blood pressure: 144/80. ENT: Right
ear with occlusive ceruminosis. Recommended Debrox eardrops and self irrigation. Left
TM clear. Nose shows 90% occlusion on the right and 80% on the left with clear
rhinorrhea. Posterior pharynx is noninjected. Neck: Supple without lymphadenopathy.
CVS: Regular rate and rhythm. Lungs: Clear to auscultation.

IMPRESSION: Rhinosinusitis.

PLAN: Prednisone 20 mg two daily for five days, one daily for five days, and one-half
daily for five days, Nasonex nasal spray one puff each side of the nose b.i.d., increase
fluids, saline gargles, steam inhalations. Follow up if symptoms persist.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Jennifer Gibby
DATE OF BIRTH: 11/10/1972
DATE: 12/23/08

HPI: Jennifer is in today follow up of her asthma. She states she is using her albuterol
much less frequently at this point of time but still has occasional days that she needs to
use it. She denies any fever, chills, or sweats. Any coughing she is having is dry and
nonproductive. She denies any wheezing. We again reviewed environmental issues.
Could not come up with anything new in her household or her boyfriend’s household.

PHYSICAL EXAM:
Vital Signs: Weight: 168 pounds. Blood pressure: 100/70 in the left. Temperature:
98.2. ENT: Basically noncontributory. Neck: Supple. CVS: Regular rate and rhythm.
Lungs: Clear to auscultation.

IMPRESSION: Asthma.

PLAN: Started on controller Flovent 110 one puff b.i.d. with spacer. Side effects
discussed, to rinse mouth with mouthwash after usage. Discussed rescue medicine for
the albuterol, set up for pulmonary function tests with bronchodilation, not to use
albuterol for 12 hours prior to the testing. Continue with her Celexa for her anxiety and
her multivitamin and Zyrtec OTC. Follow up in six weeks.

_________________

Bruce Schober, DO
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Richards Cooks
DATE OF BIRTH: 02/28/1966
DATE: 12/23/08

HPI: The patient is in today for SPE. Please see initial evaluation of 11/25/08.

PAST MEDICAL AND SURGICAL HISTORY: Denies any new med/surgical
problems.

FAMILY HISTORY: No new family history.

REVIEW OF SYSTEMS: HEENT: Head and scalp. The patient admits to occasional
scaling of his scalp, okay when he uses conditioner. He states he shaves his head. Eyes
have corrective contacts and he is optometrist in Walmart. Ears negative. Nose negative.
Mouth and Throat: Good dentition, otherwise unremarkable. Neck: Negative.
Lymphatics: Negative. CVS: Denies any chest pain, chest pressure, lightheaded,
dizziness, or shortness of breath. States he can keep up with men of his age when
working out. Pulmonary: Denies cough, hemoptysis, or sputum production. GI: He is
interested in getting his gallbladder out. Had abnormal HIDA scan and states
occasionally gets dull aching pain in his right upper quadrants. Sometimes he gets slight
discomfort into his right back. Denies any dysfunction of bowel movements. No melena
or hematochezia. GU: He does admit to occasional slight erectile dysfunction. And rest
of the meds were same. He denies any concerns of sexually transmitted diseases.
Musculoskeletal: Chronic right shoulder pain. Please see last dictation. He states when
he runs he gets an occasional slight left knee pain. Skin: Admits to thickening of his
toenails. No rashes. Grossly he has noted change in color.

PHYSICAL EXAM:
Please see PE forms.

IMPRESSION:
• Overweight. Discussed weight loss strategies.
• Decreased function gallbladder. The patient would like referral to Dr. Gilbert
and we will arrange for the same. The patient to pickup his HIDA scan from
Mountain View.
• BPH. No treatment at this time. Did recommend yearly examination of his
prostate and PSA.
• Onychomycosis. Discussed various treatments. The patient declines at this
time.
KEOWEE PRIMARY CARE & INTERNAL MEDICINE, P.C.
109 CARTER PARK DRIVE, SUITE - A, SENECA, SC –29678.
PH: 864-885-0058 FAX: 864-885-0098.

PATIENT NAME: Richards Cooks
DATE OF BIRTH: 02/28/1966
DATE: 12/23/08

• ED. Trial of Cialis 20 mg one-half to one and discussed ED in general.
• Pes planus. Discussed appropriate shoes and arch supports.
• Occasional seborrheic dermatitis. Recommended the zinc or Selsun type of
shampoo. The patient states he had labs performed at work and he is going to
bring me these in for review. He states he has these yearly. I told him that I
would recommend having a yearly PSA if this has not been done. Also monitor
lipids if not performed. Lifestyle worksheet and self skin examination
worksheet given and explained. The patient declined tetanus, diptheria, hepatitis
A and B immunizations.

_________________

Bruce Schober, DO