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you may knock in out of
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room come
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in hi Miss Alexander hi hi my name is
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Britney and I'm a medical student
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working with Dr parrot
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today try to get this all rubbed in it's
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nice to meet you nice to meet you so she
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has sent me in just to ask you some
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questions and do a brief physical exam
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and then I will step back out and talk
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to her and then she'll be in behind me
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is that okay yeah that's fine great so
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what brings you in today um I've been
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having pretty bad neck pain oh goodness
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well I'm glad you came in so we can take
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a look and make sure there's nothing
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going on so how long's this been going
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on probably about 2 days okay did
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anything happen a couple days ago out of
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the ordinary well I was in a small car
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accident okay must have been scary yeah
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what happened um I was at a stoplight
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and the person behind me rear ended me
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we weren't going very fast though I
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think he was maybe going 5 or 10 miles
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an
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hour and were were you wearing your seat
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belt at the time yeah good and um so you
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said you didn't go to the hospital or
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anything cuz you didn't feel any pain
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initially no so when exactly did the
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pain start about how many hours after
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the accident um I would probably say
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maybe four to six hours after I think
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maybe I was just in shock at first and
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so I didn't really feel any pain or
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anything all right and where is it
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bothering you specifically can you
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pinpoint a specific area on your neck
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it's mostly just the back of my neck and
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on the sides of my neck both sides yes
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right and did you hear any pops or have
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any numbness tingling that occurred
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during the accident
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no all and is there anything that's
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making the pain
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worse um mostly when I bend my head
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forward and try to turn it to the left
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it kind of I notic it little
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uncomfortable anything you've noticed
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that's helping it uh I took some
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ibuprofen and I put ice on the back of
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my neck and that helped a little bit but
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it still hurts it still hurts and how
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much ibuprofen are you taking I took two
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tablets every 6 hours or so since
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then I'm just taking some notes so that
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way when I go talk to Dr parrot I can be
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thorough and let her know everything
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you're telling me so so it's worse
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whenever you're bending forward into the
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side to the left is that correct
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yes all
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right and can you describe the pain to
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me it's just feels like a
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tight kind of
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dull pain
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okay so tight and
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dull and is this pain radiating or
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moving anywhere not really it just goes
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up and down the back of my neck so
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nothing coming down into the arms no
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okay and on a scale of 1 to 10 with 10
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being the worst pain where would you say
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you're at um probably around a six or a
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seven out of 10 especially when I try
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and Bend forward and turn my head and is
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it a constant pain yes and so but it'll
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get worse whenever you bend forward and
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turn to the left mhm
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okay and would you say since the
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accident since that evening has it been
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constant or is it getting worse better
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what would you say it feels like it's
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getting worse but I don't know if that's
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because the ibuprofen is not
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working okay well I'm glad you came in
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you know the over-the-counter stuff's
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not working and we can do an exam and
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make sure there's nothing we're missing
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and um you know if we need to possibly
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do some osteopathic treatments and we'll
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get on to that later okay okay
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and um as far as your past medical
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history have you ever had a neck injury
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before no no so you've never had
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problems with your neck no okay that's
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good to know and um any medical
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conditions that you're currently being
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treated for or that you've ever been
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treated for I have
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asthma
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um
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and I take medicine for that that's
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about it ever been
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hospitalized Noom mm ever had any
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surgeries I had my tonsils taken out
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when I was a kid I think I was probably
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nine
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okay and as far as medications you said
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you take the over-the-counter
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ibuprofen and then you take something
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for asthma what do you take for your
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asthma I take
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albuterol do you just take that as
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needed
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MH and do you take any other medications
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I take
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um a a Loratadine or a Claritin for
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allergies
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okay what about any herbal supplements
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vitamins I take a
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multivitamin and I always like to ask
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all my patients any recreational drug
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use no
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none and are you allergic to any
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medications I am I'm allergic to
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penicillin and what happens when you
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take penicillin I break out in a rash in
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a rash well we be sure never to give you
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penicillin for anything thank you and as
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far as family history um any medical
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conditions in the family with your mom
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and dad my mom uh she's pretty healthy
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she has diabetes though okay um and it's
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pretty under control good my dad has
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high cholesterol but he takes medicine
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for that
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any brothers or sisters I have a brother
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and he's healthy he do have any
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conditions or
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anything and no one's ever had um
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problems with joints or arthritis no no
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no okay
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great and I always like to just get a
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overview of my patients kind of get to
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know them a little better um what do you
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do for a living I'm an administrative
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assistant oh where do you work I work
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for the Fish and Wild Child Life
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Services oh wow that must be fun yeah
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you've been doing it for a while yeah
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for a few years okay stressful or pretty
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um it's not very stressful at all that's
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good mhm and are you married I am yeah
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congratulations thanks do you have any
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children no not yet no children no MM
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all
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right and so do you have hobbies that
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you like to do I do I like to cook and I
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like to Garden um um it's been kind of
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difficult to Garden cuz I can't lean
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forward as much for the past two days
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mhm so yeah it's can be frustrating when
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you can't do the things you enjoy yeah
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um any tobacco use I smoke um probably
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maybe half a pack a day if that and how
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long have you been
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smoking oh I want to say maybe seven
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years or so okay any alcohol use uh
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occasion
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I'll have a glass of wine with dinner
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maybe once a week
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okay all right well I believe I got all
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the information I needed from you so
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we're going to go ahead and move on to
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the physical exam portion so what I'm
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going to do is I'm just going to have
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you take a seat up
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here all right for the physical exam I'm
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going to go ahead and listen to your
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heart and long so make sure those S nice
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and
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clear so I'm just to slide this down and
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just breathe
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normal and going to take a big deep
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breath and out
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again
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again and last
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one good
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and so I'm just going to do a structural
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exam here and palpate down your spine
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let me know if there's anything that's
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tender it's tender everywhere everywhere
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okay and I'm going to work my way
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down okay and I want to check the range
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of motion in your neck so what I want
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you to do is try to put your chin down
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to your
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chest it's about as far as I can go and
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then looking up to the ceiling
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pretty
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stiff okay and what about looking
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turning and looking over to the
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shoulder okay all right and turn and
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look to that shoulder for
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me right there and then ear to your
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shoulder trying to touch your ear over
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to your
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shoulder and then ear to the other
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shoulder that's as far as all right and
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I'm going to go ahead and check just
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some
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reflexes this will kind of tell me if
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there's any nerves that are involved so
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just relax your
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arm and we're going to rest your arm
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right here on your
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lap and just
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relax good and I'm going to do the same
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thing on this arm just relax your
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arm and just
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relax and then last one just let your
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arm hang
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and now I'm going to test and see how
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strong you are so place your arms like
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this for me and don't let me move your
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arms
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good and arms up and don't let me push
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them good and fingers out for me don't
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let me squeeze them and fingers together
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and try to push them out okay all right
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if it's okay with you as an osteopathic
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student we learned some treatments so
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I'm going to do some soft tissue to try
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and break up some of this tension that
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you're having if that sounds okay okay
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hurt too bad no it's not going to hurt
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and if there's any pain I want you to
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let me
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know and so I'm just going to do just
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very gentle it's called mile FAL I'm
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just kind
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of slowly
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up and if this is something that you do
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get some relief from after this evening
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then you can come back and we can be a
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little more aggressive but since the car
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accident was just two days ago I want to
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be very gentle
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okay okay I'm just going to hold this
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right here all those muscles that are
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tight and spasming right now attach
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right up where my fingers are at so I'm
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just trying to get them to relax and
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loosen
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so this is supposed to relax all the
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muscles of my neck yep
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okay all right I think that'll be enough
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for today I don't want to do too much
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since it was such an acute injury so I'm
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going to go ahead and help you
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up and then I'm going to go ahead and
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summarize everything that you told me
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from earlier if that's okay um would you
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prefer sitting back down in the chair
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sure okay so you started having some
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neck pain two days ago after a motor
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vehicle accident um you were rear ended
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but you were wearing your seat belt you
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didn't hear any pop or have any numbness
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or tingling that occurred and it's just
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been real tight um for the past 2 days
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real constant but it's worse whenever
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you flex your head down or turn to the
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left is that correct yes and as far as
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your past medical history um you just
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have asthma and you're taking some
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medication for that um okay and you're
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not allergic to anything anden a or
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excuse me yes that's right you are
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allergic to penicillin all right what I
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will do is I will go talk to Dr parrot
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and then we will be back in to put
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together a treatment option plan for you
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okay um any other questions or concerns
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you have for me today no I don't think
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so just want to feel better all right
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well that is our main goal so I'm glad
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you came in today great thank you thank
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you