D: Would you mind by starting with what brought you in today?

P: Yeah, so I'm just coming in with my son. He's six years old and yeah, just over the last few days he's not been himself and he's been having this stomach ache. Uh, so it started around like I would say 3 days ago and then he's also having vomiting for the last two days, he's vomited in total six times over the last two days and then yesterday he also developed a fever as well. I managed to measure it and it was 38.3 degrees Celsius.

D: OK, I see. So I just so that I understand the timeline, so he started to have abdominal pain about 3 days ago, started with having vomiting and diarrhea two days ago and you checked his temperature, he had a fever as of yesterday?

P: Yeah.

D: OK, and uh, was there anything that that he ate that was different over over these last few days?

P: No, we've been strictly home food during like a pandemic like no, no real changes.

D: OK, and what's his kind of behavior been like over these last couple of days?

P: Yeah, so at first with the stomach pain he was a bit just irritable and just not himself, but especially yesterday with the fever just been very quiet and just kind of sleeping pretty much the whole day.

D: OK, I see and uh, could you describe the vomit?

P: Yes, so vomit like, it started two days ago. The first day it was just like he puked up the things that he had eaten, but yesterday it was it was mainly just like uh just yellowish material, I couldn't really tell if it was food or not.

D: OK, have you noticed any bile or blood in the vomit?

P: Uh no I didn't notice any blood and I didn't notice any green material. It was mainly just like like normal vomit, like yellowish color.

D: OK, I see and, has the what was the vomiting triggered by anything that you're aware of, like eating or drinking?

P: Uhm? Yeah, two days ago it was it was after after lunch when he first vomited. But after that it's just been kind of random.

D: I see OK, and, uh, and with regards to his diarrhea, has there been any any blood or or any color changes?

P: No, no, I didn't notice any blood at all. It's definitely just very very watery and he's had to go probably even just in the last day, probably around like six or seven times.

D: OK, um, and he's vomited how many times?

P: So in total I can count 6 times.

D: OK, and, has he been complaining of any headaches at all?

P: No, not that I know.

D: No. OK, and how about any ear pain or or eye pain?

P: No, not that he's mentioned to me.

D: OK, and any eye redness?

P: Nope.

D: OK, and as he had a runny nose?

P: No, not really.

D: OK and has he had a sore throat or any pain with swallowing?

P: No.

D: OK, have you had any loss of taste or loss of smell?

P: Uh no, not that he has mentioned to me now.

D: OK, and has he had a cough?

P: Uh, no, not really.

D: OK, and how about any shortness of breath or wheezing?

P: No.

D: OK, and has he had any any pain anywhere? Any chest pain?

P: Um, he did, he did point to his stomach like it seems like he was having with all the vomiting like, he was having some stomach pain as well.

D: OK, is there any specific location that that he's feeling the pain?

P: Well, it's hard to say. He was just pointing at the center of his belly like, I don't know if it's like, I tried pressing on it and he didn't feel any pain then, but I think it's just kind of all over his stomach.

D: OK, and has he had any urinary problems like painful voiding or been peeing more often?

P: No, that's been OK.

D: Have you noticed any rashes or skin changes?

P: Uh, no, not not really, no.

D: OK. And has he had any muscle aches or uh, or joint pains that that he's mentioned?

P: No, no he hasn't mentioned anything like that.

D: OK, and he's had a fever, has he had the chills?

P: Yeah, so that's that's what I, that prompted me to take his temperature yesterday around the afternoon, like we had to wrap him up with like more than two blankets and he was still feeling cold so, yeah, definitely was having chills.

D: OK, and and has there been any concerns with his growth, either weight or or height?

P: So he's been going along the charts pretty well, like no concerns during his growth. Otherwise, he's a very healthy child.

D: OK, so no medical diagnosis previously?

P: No nothing like that.

D: OK, and uh, yeah, is he meeting all developmental milestones OK? Like gross motor, fine motor, doing well at school?

P: Yeah yeah, he didn't have any issues with walking, running, he's pretty social with all his peers. He's doing well at school, no complaints.

D: OK, excellent and you know, no medical conditions, but has there been any reasons for being in the hospital before?

P: No, not at all. We, yeah, we haven't really gone to the doctor with him after like all those vaccinations that he had to do, so he's been good.

D: OK, great, so immunizations are up to date?

P: Yeah, immunizations all up to date.

D: Excellent and does he have any allergies?

P: Uh, no, uh, not not anything that we know of yet.

D: OK, and I just wanted to ask about his birth history. Were there any complications throughout throughout pregnancy, either mom being sick or having any any issues herself?

P: No, so it was a normal vaginal delivery, uh no issues, uh he was born at 39 weeks, didn't need to stay in the hospital at all. Yeah, it was a pretty smooth pregnancy compared to some of the other ones.

D: OK, oh, that's that's great. Do you remember the Apgar score or his birth weight?

P: Uhm, I don't exactly remember his Apgar scores, I think they were like just just they they were normal like there was nothing concerning about them, and birth weight I think he was probably around 3 kilograms.

D: OK, great so, yeah healthy birth weight at term it sounds like. And so, healthy, does he take any medications regularly?

P: No, no medications.

D: OK, and could you tell me about who is living with currently and then who's looking after him?

P: Yeah, so he's living with myself, his mother and, and then my husband, and he has two older siblings. One is a boy, seven years old, and another one like a 10 year old girl.

D: OK, and has anybody in the house been sick?

P: Uh no, no one has been sick recently, however he does, they did let them go back into school at one point, so I don't know, I don't know, so that was just last week, so I don't know if he caught something from school.

D: OK, but nobody that you know that's had similar symptoms?

P: No.

D: OK, and have you traveled anywhere?

P: No, we've been, we've been at home.

D: OK, uh, and then you know recent changes to anything in the diet you've mentioned?

P: No, that's been fine.

D: OK, and any concerns for safety in the home, whether physical or or verbal abuse?

P: No, no concerns like that.

D: OK, yeah a question that we have to ask everybody and is there any smoking in the home?

P: No, no, we don't smoke.

D: OK, great then, are there any pets?

P: Nope, no pets.

D: Alright, and uh and in the family, has there been anybody who's had any heart problems or any lung problems?

P: Uh, we are getting the 10 year old tested for just uh, asthma.

D: OK.

P: But nothing diagnosed yet, no.

D: OK, anybody in the family have any congenital diseases or any genetic diseases?

P: No, not that I know of.

D: OK, uh, anybody in the family have celiac disease or Crohn's disease?

P: No, no, uh no history of any kind of bowel diseases.

D: OK, so I think that's, uh, everything I want I wanted to ask about today. Uh, was there anything that maybe I I forgot to ask or or that I missed that you wanted to tell me?

P: Uh, yeah, no it's, it's also just like I was just reading up like, can it be like I don't know if it can be COVID as well, if it can, it can do this as well?

D: It is possible. Uh, it's uh, especially with nonspecific symptoms, COVID can cause a variety of different presentations, and there for some people it can be more gastrointestinal issues like like your son has with vomiting and diarrhea and belly pain. But it also could be well, uh, another type of gastrointestinal virus itself or or a viral illness like the common cold, which can also end up causing symptoms like this as well. So we will, I will go ahead and do a COVID test today, along with some other blood work. And maybe increase the hydration as well, because it sounds like he has lost a lot of fluid over these last couple of days. So we will check electrolytes and go from there on the test results.

P: Alright, sounds good. Thank you so much.


D: What brought you in today?

P: Yeah, so uh, just randomly like 2 days ago I just started having this chest pain when I'm breathing and it's just been getting worse and then because of that, I'm finding that I'm very short of breath as well, so I just got really concerned.

D: OK, I see. When did the chest pain start?

P: So, there was some discomfort like just 2 days ago, but then just yesterday it started getting very painful when I was breathing. So yeah, I would say 1 day ago.

D: OK, and were you doing anything at the time when the chest pain started? Like did you get in a car accident maybe? Or any trauma to the chest or anything you can think of?

P: No, not really. I was just at home and then I noticed that when, I like, take a deep breath in, it's just, like, a very sharp pain. It's kind of like in my right side of the chest and it feels like a stabbing pain.

D: OK, and so the pain comes on when you breathe in, or yeah, when you take a deep breath. Does the pain come on at any other points or does it go away?

P: Uh, it's mostly, yeah, I feel the sharp pain when I breathe in.

D: OK, so the pain is intermittent then, it sounds like. And has there been anything you've tried that's made the pain better?

P: Not really, just more shallow breathing, and it hurts less with that, but that's about it.

D: OK, and are there any positions that help make the pain any better like leaning forward or laying down?

P: Not really, it's uh, it's pretty much the same, I think.

D: OK, and uh, you mentioned you had shortness of breath as well. When does this come on?

P: Since yesterday it's been pretty constant and it's more like, Uh, just uh, I'm really having trouble getting any deep breaths in, so I feel like I'm having to just breathe faster and more shallow.

D: I see, OK, and has anything like this happened to you before?

P: No, never.

D: OK, and have you been experiencing any headaches?

P: No.

D: How about any viral symptoms, like eye redness, nasal discharge, or nasal congestion or cough?

P: I have been having a little bit of a cough, but that's it, like, it kind of started today, but it's nothing too significant.

D: OK, alright, is the cough dry or have you brought up sputum?

P: It is dry.

D: OK, and have you had a sore throat?

P: Uh, no.

D: How about a loss of taste or a loss of smell?

P: No.

D: OK, how has your appetite been?

P: My appetite's been pretty good. It's like, definitely with the pain, I don't really feel like eating today, but I don't think it's changed.

D: OK, so has your weight been stable over the last several months.

P: Yeah, weight has been stable.

D: OK, and have you had any fevers, chills, or night sweats?

P: Uhm, Nope.

D: OK, and have you had any episodes where you feel like your heart is, like, racing or beating out of your chest?

P: No, I don't think so.

D: Any dizziness or Lightheadedness?

P: No.

D: OK, and have you had any wheezing?

P: No, I don't think so.

D: OK, and with the cough, have you brought up any blood?

P: No.

D: OK, and have you had any, Uh, like urinary problems?

P: No.

D: Any bowel problems like diarrhea or Constipation?

P: No, nothing like that.

D: And any abdominal pain?

P: No.

D: Have you had any nausea or vomiting?

P: No.

D: OK, and have you had any muscle aches, joint pains or skin changes?

P: No.

D: OK, and uhm, in the past have you been diagnosed with any medical conditions?

P: No, I've been pretty healthy.

D: OK, so do you take any medications regularly?

P: No, nothing at all.

D: And do you have any allergies?

P: No, no allergies.

D: Any hospitalizations in the past or any surgeries?

P: No.

D: OK, and currently, can you tell me just a little bit about your living situation?

P: Yeah, so I just live with uh, a couple of my roommates. I'm going to University.

D: OK.

P: I live in like a student housing situation.

D: OK, has anybody in the house been sick or anybody that you've been around been sick?

P: No, we've been all pretty healthy.

D: OK, and do you smoke cigarettes or use any like vape products or anything like that?

P: No, I haven't ever smoked. I do smoke weed like, I would say, once or twice a week.

D: OK, and how much would you say? Like 1 gram or less or?

P: 1 gram probably lasts like 2 weeks.

D: OK, and do you drink alcohol?

P: Yeah, just a couple of beers maybe on the weekend.

D: OK, and are you currently sexually active?

P: Yeah, just one partner, my girlfriend.

D: OK, and, do you use condoms?

P: Yeah, we use condoms, we're pretty safe.

D: OK, and have you had a sexually transmitted infection before?

P: No, never.

D: OK, any concerns right now or anything like that?

P: No, uh, we've been pretty safe and we've both been tested before and everything, so I'm not really concerned.

D: OK, great and has anybody in the family had like a similar presentation before, like any lung problems or heart problems?

P: No, I think my sister, she has asthma, but that's about it.

D: OK, and uh, any cancers that run in the family?

P: Not that I know of.

D: OK, so it sounds like you had this uncomfortable feeling in your chest about two days ago, but the pain really came on yesterday and it's really painful when you have a deep deep breath. So, in conjunction with your symptoms of not being able to take a deep breath and being short of breath, it sounds like you possibly have what's called a pneumothorax and so we'll do a physical exam and do a chest X-ray as well to examine this and check vitals as well to make sure that you're work of breathing is OK and we can do some blood work and go from there.

P: OK, yeah, sounds good. Should be like, worried at all?

D: I think right now, you're speaking in full sentences and you're not short of breath at rest, typically, when this this happens, if it's small enough, it'll usually resolve on its own and so we'll get some more information from the imaging and the lab results, but it's reassuring that you haven't been getting worse since it happened.

P: OK, alright, sounds good. Thank you so much.


D: What brings you in today?

P: I've just been feeling like very nauseated for, it feels like all the time right now.

D: When did this start?

P: It's been over a week. Maybe not quite two weeks, but like around then. Yeah, maybe like 9 days.

D: And um, is it, do you always have the sensation of nausea or is it related, or does it come and go?

P: Oh, I think it's like worse when I am smelling something really bad, and it's worse in the morning. But I feel like it's always kind of there.

D: I see OK. Um, have you had any vomiting?

P: Uh, yeah, like um, yeah, like a lot of days I'll throw up like once or twice.

D: And this has all been over the past week, week two weeks or so?

P: Yeah.

D: OK, um, any other symptoms that you have?

P: Oh no, just, well, like I feel like I've I've had to pee a lot more. Um, but I don't, I don't think that's like related. I think maybe I have just been drinking a lot of water, so yeah.

D: How often do you have to pee?

P: Oh, like, I feel like every couple hours right now.

D: OK, so say every two hours, every hour, every five hours?

P: Probably every probably every like 2, maybe, maybe every hour I get certain times in a day.

D: Do you wake up at night to pee?

P: Oh, like it doesn't wake me up but it's like I wake up because I hear something. Then I'll be like, oh I think I should probably go to the bathroom.

D: Yeah, do you feel like you have control over when you are going to bathroom or is it difficult for you to hold it in?

P: Oh I I I can control it. It's just like uncomfortable right?

D: I see I see so, um, you have urinary frequency, but do you do you feel like, uh so you said that you can control it, you don't you don't feel like you need to run to the bathroom or you'll pee in your pants?

P: No, I don't feel like that.

D: OK. Do you have any pain when you're peeing?

P: No.

D: No, OK alright um, do you feel like you've been more thirsty recently? Why do you feel you've been drinking more more water?

P: I think, I think just 'cause like I was getting I was like throwing up like so like I feel like I was a little dehydrated.

D: Um, I see OK, um, have you, other than the nausea and vomiting, have you had any other stomach related issues? Any belly pain or changes in your bowel movements?

P: Ah no, I don't think so, well my stomach has been like it feels like a little crampy. I thought that maybe it could be my period but like I'm not on my period.

D: When did you last have your period?

P: Oh well, let me think. Um, like six weeks ago. I guess that would be, I don't know. I don't really like keep track.

D: OK, OK. Do you know if you get your periods regularly or are your periods irregular?

P: I think they're I think they're usually pretty regular, but I don't I don't like I don't
calculate it like to the day.

D: True yeah, is it is it normal for you to go six weeks without a period?

P: Oh, come to think of it, I don't, I don't think so.

D: Alright. Um, OK. Uh, have you, I'll just ask you a couple more questions about your symptoms. So I know that you've been nauseous and have vomited a couple of times in the past two weeks. And, you have had some cramps in your belly. Have you had any flu like symptoms?

P: No.

D: Nothing like that?

P: I don't think so.

D: Any headaches?

P: Uh no.

D: Any fevers?

P: No.

D: Muscle aches?

P: Uh no.

D: OK, um, have you, have you had a cough at all?

P: Oh no.

D: OK, and have you noticed any blood in your stools?

P: No.

D: Have you, you haven't had any palpitations or chest pain or anything of that sort?

P: No.

D: Alright um can you tell me about your past medical history, any medical issues medical conditions that you have?

P: Uh, nothing, nothing really.

D: OK. Have you, um, been taking any medications?

P: No, I mean, I've been taking like like I've been chewing like those ginger things that are supposed to help with nausea, but they weren't really helpful.

D: I see. Any allergies?

P: So just like nickel, like in jewelry, if I wear not real jewellery, it'll give me a rash, but it's not food or like or medications or anything.

D: Um, and, uh, a couple of questions about your social history. Who do you currently live with?

P: Um, like I I just I live with one roommate.

D: Um and, do you currently smoke?

P: No.

D: Alright, you don't smoke, OK. Have you, do you consume alcohol?

P: Uh, no, very rarely because I always get a headache.

D: OK, when was the last drink that you had?

P: Oh gosh, like like a month ago probably.

D: OK, um, and you consume any illicit drugs?

P: No, no.

D: Alright, are you currently sexually active?

P: Yeah just like with my boyfriend.

D: And do you use protection while having sex?

P: Yeah, we we just use condoms. I used to be on birth control but it always made me
feel like like kind of sick so I don't use that anymore.

D: Mhm, I see, OK. Uh and um, let's see. Family history. Do you do you have any medical conditions that run in your family?

P: Uh, like I don't, I don't think so. I guess my dad my dad has like high blood pressure, yeah, I don't think there's anything else.

D: Alright, alright, well, thank you so much for spending time with me today. I think I have gathered all the information that I would have liked. I will go talk to my attending, we'll come back and maybe ask a couple more questions and then share the plan with you.

P: OK, thank you.

D: You're welcome.


D: What brings you in?

P: Hi, I've just had a runny nose and a cough for the past uh week.

D: OK, um so for the past week you said, did the cough start first, or the runny nose?

P: Uh it started with the cough. I usually don't come in when I have symptoms like this uh, but I've just been, uhm, I just heard of someone who passed away due to Covid and I'm just like very scared and I just decided to come in.

D: Yeah, for sure that's understandable. Um With the cough, is it a dry cough or are you bringing up some phlegm?

P: Um it's mostly a dry cough

D: Dry cough. OK, um and is it persistent or does it come and go?

P: It comes and goes. It does get better when I um take um like over the counter medications for for um like the antitussive pills.

D: OK yeah yeah. Um and does anything make it worse like the cold air or certain times of the day or like when you're laying down?

P: Um the cold air does make it a little bit uh worse.

D: OK. And have you experienced something like this in the past?

P: Uh yeah, I usually I do get a cold um couple times a year.

D: OK yeah, that makes sense. Um and any shortness of breath?

P: Um no, no I don't think so.

D: No, any wheeziness?

P: Um no.

D: Chest pain?

P: No.

D: Um, how about a stuffy nose?

P: Yeah, I do have a stuffy nose.

D: OK, when your nose does run, do you notice that it's like uh yellow in colour or red?

P: No, no.

D: No, OK, so it's clear?

P: It's clear, yeah.

D: OK, any changes in your vision or hearing?

P: No.

D: Smell or taste?

P: Um I I can't smell as as much, but I think maybe it's just because my nose is so stuffy, but also that made me a little bit concerned about Covid, but no problems with taste.

D: OK, good any weight loss recently?

P: Um I've been trying to lose weight, but nothing unintentional I guess.

D: OK yeah, and then any fevers?

P: Uh no.

D: No fevers huh, OK. Any like excessive fatigue?

P: I am tired but not, I guess it's not too bad.

D: Yeah OK, and how about like rashes?

P: No, I haven't noticed any.

D: No rashes, OK. Um any uh, sorry, I asked you if you had chest pain, uh do you ever feel like your heart's racing?

P: No.

D: No, OK. Any changes to your bowel movements?

P: No.

D: No, um nausea or vomiting?

P: Uhm, no.

D: No, OK. Uhm how about headaches?

P: Uhm, no.

D: Fainting spells or dizziness?

P: No.

D: Joint pain?

P: Um no.

D: No, OK.

P: Just my body feels a little achy, but.

D: Yeah.

P: No like specific joint pains.

D: OK, and then any uh major illnesses that are longstanding?

P: Um I don't know does depression count? I do have depression.

D: OK, yeah, for sure. How, when were you diagnosed with depression?

P: Uh when I was 15 years old.

D: 15, OK. Um are you on any medications?

P: I'm I'm on Prozac.

D: Prozac, OK. And when were you diagnosed uh, prescribed that?

P: Um I've just been on different medications uh over the past few years. Um this one seems to be working well. I started this about a year ago.

D: OK good good, any allergies?

P: Uhm, no.

D: Are you up to date with all your immunizations?

P: Mhmm.

D: Um any family history of lung or heart disease?

P: Uh, just um high cholesterol.

D: OK. Um how about smoking, do you smoke?

P: No.

D: Um any other recreational drugs like marijuana?

P: Um yeah, sometimes. I'll just have a joint um maybe um two or three times a week.

D: OK, OK. And is that for like medical purposes or just like recreationally?

P: Uh just you know just to relax.

D: OK, sure. Um alcohol?

P: Uh no.

D: No, OK. And have you been around any sick people recently?

P: Um I went to I went grocery shopping and and someone near me was coughing. I was still like six, you know, I was away from them but, I don't like, yeah, I don't know.

D: Yeah, for sure. I think that you're, it's fair that you're concerned about that. And how about travel to anywhere?

P: No, I haven't traveled anywhere.

D: No, OK. OK, well those are all the questions I had for you. Did you have any questions of your own?

P: No.

D: No, OK. So we'll do a covid swab anyways today because your, some of your symptoms do overlap with that of Covid and you should hear back in about 24 to 48 hours. But in the meantime you should self isolate for 14 days.

P: Sure.

D: Um but it I think it does really sound like you have a common cold um so just like another viral illness, um so just treat it supportively you know um keep yourself hydrated, if you feel like you're getting a fever, take like Tylenol. Um if you have like pain like a headache or like sinus pressure or something you can take again an Advil or Tylenol. Um And if your symptoms worsen, or if you have any neurological symptoms, then you should see the ER um right away.

P: Sure.

D: Yeah, OK sounds good.

P: Great.


D: How can I help you?

P: Hi, my son Dave who's 5 years old, who comes to the clinic quite often, has uh, his asthma has been really bad over the past few days. I've tried his puffers, but they're not really helping much, and I'm just worried about him.

D: So what symptom is he experiencing now?

P: Uhm so, he's just having this wheezing that just doesn't go away, like, I can actually hear it, it's frightening, he's having like he's having difficulties falling asleep, he's just been very irritable, uhm, he didn't go to school yesterday. It's just, yeah, it's just, it seems like, it's just, he's not eating well either.

D: OK, so yeah, it's been affecting, uh, sleep, appetite, his mood, has he been short of breath?

P: If he was like, he said that he was having some difficulty breathing, yeah.

D: OK, has he, uh, able to talk like in full sentences, like, how is he right now?

P: Yeah, he's  able to talk in full sentences but he just gets a little bit breathless when he's eating, which I think is probably why he's not eating much. But yeah, he's able to talk, he's not talking much either, just been like, just been in a mood, you know, he gets a little bit breathless when he's crying.

D: OK, I see, and, has he had a cough?

P: Yeah he does, he does have a cough, yeah.

D: OK, and when did the cough start?

P: I want to say about two days ago.

D: OK, and has he been bringing up any sputum?

P: No.

D: Or any blood?

P: No no no.

D: OK, and has the cough been getting any better or any worse?

P: It's been the same.

D: OK, uhm, and has he complained of having a sore throat or painful ears?

P: No, he hasn't complained of those.

D: OK, and have you noticed any eye redness or or any discharge from his eyes or nose?

P: No.

D: OK, and has he been having any chest pain?

P: Uh, no.

D: OK, and you mentioned, uh, a wheeze, have you been able to hear a wheeze like this before?

P: It's usually not this bad.

D: OK, has he been having any abdominal pain?

P: No.

D: Any nausea or vomiting?

P: No.

D: Has he had any urinary problems like, painful when he's going to the bathroom?

P: No, he hasn't complained of anything like that.

D: I see, OK, and has he had any diarrhea or Constipation?

P: No.

D: OK, has he had any skin changes or rashes?

P: No, no, I checked for those very carefully. He used to get rashes when he was a child, but no, he doesn't, he doesn't have anything right now.

D: Alright, and has he had any muscle aches or joint pains?

P: Uh, he's just been, he's just been not, he's not been as active as he usually is, so I don't, he hasn't said that any anything in particular about muscle pains, but I don't know if he knows how to, you know? He's just been, yeah.

D: OK, and two days ago, can you think of any triggers like, was there any exposure to dust or smoke or maybe even pets that could have brought this on?

P: Yeah, you know, if I think about it, he did go outside to play with his brother and, I don't know he might have got something out there maybe.

D: Yeah, uh, certainly possible and was it like a particularly cold day?

P: Yeah, it was a very windy, little bit chilly too.

D: And when, like, during the winter time, does cold air trigger attacks for Dave?

P: Oh yeah.

D: OK, and how about exercise?

P: No, I don't think, well, they went outside to play, so I mean he was, uhm, exercise does make it worse sometimes, so it could be that too.

D: OK, and so, has dave been experiencing any other symptoms besides the the wheezing and the irritability and what you've described so far?

P: No, I don't think so, that's, I think that's it.

D: OK, you tried some inhalers, how often have you been using them?

P: Yeah, we used his blue inhaler about five times yesterday, and another two or three times earlier today.

D: OK, and do you use a spacer?

P: Uhm, no we don't. I have to go get that and learn how to use it.

D: OK, for sure we can go through, Uh, the proper technique, throughout this visit as well, just to review that again.

P: I would love that.

D: That's great, and has he been using any other medications to help over these last couple of days besides the inhalers?

P: No, just the inhalers, we've also kept it the usual one, the one that he takes, the other inhaler.

D: OK, does he have one that he uses, once, like, he uses daily?

P: Yeah, yeah the one that he uses, I think the orange one.

D: OK, so he does use a steroid inhaler?

P: Yeah.

D: OK, and does he have any allergies?

P: Uhm, no he doesn't.

D: OK, and does he have any medical conditions that have diagnosed previously?

P: Just the dermatitis and asthma?

D: OK, and when was his last asthma exacerbation?

P: Last year.

D: OK, has he ever needed to be hospitalized for one?

P: Oh no, no, nothing like that, he's a healthy kid.

D: OK, that's good, has he had any surgeries before?

P: No.

D: OK, and in regards to birth history, were there any complications throughout pregnancy or with delivery?

P: Oh no, everything was normal. He was born via vaginal delivery and no complications. He was a healthy baby.

D: OK, and have you had any concerns with growth or developmental milestones?

P: No, no, the doc was pretty happy when he did the regular, the checkup and yeah things are good with him, he's a good kid.

D: Awesome, OK, and could you tell me a little bit about the living situation, like who's the main caregiver and who he's living with?

P: Yeah, so he lives with me, his dad and his brother who is 2 years older and he's not going to school right now. We're just keeping him at home due to Covid and trying to do some home schooling. I'm a homemaker, so I do have enough time to spend time with him and his older brother and, yeah.

D: OK, has anybody in the home been sick, either his brother, yourself, or father?

P: Uh, no.

D: OK, and anybody, at work or any other places that you maybe traveled to, that, uh, been around anybody who's been sick?

P: Uhm, no, I don't think so. I don't think there was anyone that was sick.

D: OK, and have you traveled anywhere recently?

P: No, no. We're just staying at home.

D: OK, and are there any pets in the home?

P: No.

D: Alright, any carpets or like, uh, curtains or anything like that, covering the windows?

P: No, we got all those removed when he had his big exacerbation last year.

D: I see, OK, and does anybody smoke in the home, either cigarettes or marijuana?

P: Uhm, my husband smokes, but he smokes outside, he never smokes in front of the kids.

D: OK, I see, and uh, does anybody in the family, have any heart or lung conditions?

P: No, uhh, I have some, I have high blood pressure but that's it

D: OK, any, like, congenital diseases that run in the family?

P: No.

D: Or how about any genetic diseases?

P: No

D: Cystic fibrosis or anything like that?

P: No no, no.

D: OK, uhm, so was there any other, anything else that maybe I forgot to ask about or I'm missing that you'd like to add today?

P: No, I'm just worried that he's going to have a big asthma attack like last year, I just also want to make sure nothing else is going on and if he can be taken care of and he's just, he's feeling awful.

D: For sure, yeah, we'll, uh, check his his vital signs and do a physical exam. And it does sound like it could be an asthma exacerbation, and so we can trial some inhaler medications, a little bit different than what you use at home. But also using Ventolin as well and we'll assess the need for potential, uh, antibiotics and also steroid if necessary and if his breathing gets worse or you're starting to hear that the wheezing is getting worse or his work of breathing is becoming more intense then certainly we'll need to add on some oxygen and possibly, some other therapies.

P: Thank you so much doc.

D: Alright, thank you.


D: What brings you in today?

P: So I so I have COPD and it's usually like pretty manageable with my puffers and that. But just in the last like 3 days I feel like it's gotten a lot worse. You know, I, I feel like I'm coughing more often and I'm now, uh, kind of producing more sputum. Kind of like a green yellowy sputum uhm. I even notice that there is like a little bit of blood a couple times when I was like, really coughing hard. I’ve been finding it like harder to breathe than usual. I don’t have home oxygen or anything, and I'm not. I didn't think I was quite there yet, but this these last few days it's been. It's been really hard to breathe.

D: I see OK, so this is happened in the past three days. Have your symptoms gotten better or worse over this time?

P: I feel like they've been get maybe maybe getting a little worse. They definitely haven't gotten better,

D: OK, and has this ever happened to you before?

P: I’ve had I had some troubles like when I've been sick before where the cough is gotten pretty bad. This is probably this is probably the worst that I've had, but I have like I have had in my COPD been made worse by being sick.

D: I see OK. Well, I guess the first thing we're going. So how's tbad, how bad is your shortness of breath?

P: Like I I walked here fine, but I normally like can walk around the block and I go for a walk, usually a couple times a day to walk my dog and it's been just it's been a little bit trickier to do that.

D: I see OK. And uh have you ever had any hospitalizations in the past specifically for COPD exacerbations?

P: Um I haven't. Uhm, like stayed over in the hospital. I like come to emerge a couple times.

D: Alright um. How many times?

P: I think twice maybe over the last like three years.

D: Uhm when were you diagnosed with COPD?

P: Uhm 4, 5 years ago?

D: Was it formally diagnosed using the proper testing?

P: Yeah, they referred me to a lung, a lung doctor.

D: I see OK. And have you had any fevers or chills?

P: I feel like I may have had a fever last night. I felt really hot.

D: Did you check your temperature?

P: I I don't have a thermometer at home.

D: No problem. We can now check your temperature.

P: Here by the bed. I would say had a fever.

D: Sure. And. Have you had any other symptoms? So have you had like a runny nose or stuffy nose? Any pain in your sinus?

P: I think I think I have a I've had a bit of a like this pressure in the sinus area, but it's been the cough has been the thing that's been the most bothersome.

D: I see and have you had a sore throat at all?

P: Oh no.

D: OK. A headache?

P: Uhm? Maybe a little bit, yeah.

D: OK and any nausea or vomiting?

P: No.

D: Diarrhea or Constipation?

P: No.

D: Abdominal pain.

P: No.

D: OK. In have you recently lost weight unintentionally?

P: No no, I wish but no.

D: OK. Have you had any night sweats where you feel like you're drenched in sweat at night?

P: Uh, no, nothing like that.

D: Alright. And have you had any exposures to anyone who could potentially be sick?

P: Um. Let me think I I meet my I meet a couple of friends to walk our dogs together outside and one of them was a bit sick for a bit. We try not to get too close, but maybe I don't know. Maybe sometimes we walk a little too close. We feel too safe 'cause we're like outside.

D: OK, OK um. And did your friend get a covid test done?

P: Uhm? I don’t know.

D: That's OK. OK, and you mentioned that you had COPD that was diagnosed four or five years ago. Any other medical conditions that you've been diagnosed with?

P: Um. Yeah I have a high blood pressure.

D: OK, and are you taking any medications?

P: I’m not, I'm not I we talked about it, but I decided to try to change my lifestyle as much as I could 1st and I've also done that for the COPD. It's generally pretty like I've been really trying to take care of it, but um I feel like I maybe got sick or something this time, yeah, so my blood pressure is like OK right now.

D: OK, OK.

P: My pressure and then I lost weight and started this walking more.

D: That's great. That's really, really good that you're taking better care of yourself. Should definitely continue doing that.

P: Right?

D: And you've mentioned that you have some puffers. How often do you use those?

P: Oh like I have the one that I use every day. That I'm supposed to just use no matter what, and then the one that I use when kind of just when I need it. I probably use it like once every two weeks.

D: OK. OK. Uhm? And you mentioned that your COPD’s are getting better. Do you find that it's affecting your life in any way affecting the way that you're doing your daily activities at at home or at work, if you are working?

P: I like pretty OK except for like if I get sick I so yeah, it's been.

D: I see.

P: So I think it's like pretty well managed like I stay on top of my lifestyle now.

D: Thats good, thats good. Do you have any allergies?

P: Uh, no, no.

D: No, no allergies to medications ?

P: No.

D: OK, OK, good and. Do you, just a couple more to general questions. Have you traveled anywhere outside the province recently?

P: No.

D: You, I guess I should have asked you earlier, but have you noticed any change in your sense of smell?

P: Uh no, I don't think so.

D: Any change in your sense of taste?

P: Uhm? No, I don't think so.

D: Any confusion or fuzzy feeling?

P: Nope.

D: No OK, any muscle aches in your body?

P: Uh no.

D: OK, alright, and just kind of some questions about your living situation. Do you currently live alone? And I you mentioned that you have a dog? Are there any is there anybody, anyone else in the house?

P: Uh my husband.

D: OK and. Do you currently work?

P: Yeah, I uh, like I've been working from home. I worked for the municipality.

D: I see. Do you think you might have had any exposures to say dust or smoke or anything like that that could have worsened your symptoms?

P: I don't think so.

D: And do you drink alcohol?

P: Oh, very rarely .

D: OK do you smoke?

P: I used to. I quit once they said I have COPD. I smoked 1/2 pack a day for probably 20 years.

D: OK, OK, and do you consume marijuana or any recreational drugs?

P: No.

D: OK, uh, alright, well I guess one more question, are there any lung diseases or heart conditions or cancers that run in the family?

P: No, nothing that I can think of.

D: Alright, well that's those are all the questions I had for you. I will now do it physical exam and look at your vitals and listen to your chest. It's likely that what you have right now is COPD exacerbation, maybe just a like an infection that you got, which worsened some of your COPD symptoms. We would also have to rule out covid, so we'll be doing a covid swab and will decide based on the on your labs in your vital signs. It's instead of other things whether you need to stay in the ER and be admitted, or if you are good to go home, I will also talk to my attending and will make those decisions together and come back and talk to you. Does that sound good to you?

P: Yeah, that sounds great. Thank you.

D: Your welcome.


D: Would you mind by start starting to tell me about what brought you in today?

P: Yeah, I I. It's just over the last week I can't like do anything without just feeling really like short of breath. I'm having a really hard time breathing. Like kind of do anyways because I have COPD. So I feel like over a few years it's been getting worse, but this week it just got really bad in particular.

D: OK, I see so. How much activity were you doing that was bringing on, the shortness of breath?

P: Like I, I usually I will walk my dog around the block and I haven't been able to do that like my husband's been doing it. And then I was just going to try to get the mail just like. I don't know. It's probably like 200 feet down the road and I could, I was so tired when I got back and I felt like I could barely breathe.

D: OK, and did you have any chest pain with this?

P: Uh. No, no, nothing like that.

D: OK, and when did the shortness of breath symptoms start coming on?

P: Mmm like it I've been. I feel like it's been sort of getting worse over the past few years. But just like a week ago, it just got really bad. Like very suddenly.

D: OK, um, and has it been getting worse over this past week or has it stayed the same?

P: Pfft maybe getting a bit worse, like it's been pretty bad the whole time.

D: No, OK, I see, and have you had a cough?

P: Yeah, like I again like I do normally because of my COPD but. It's just been really. It's been even worse this week, and usually when I get sick it's more like I'm like bringing up a lot of like yellowish gunk, but this time it's not been quite as like gunkie. It's been pretty dry.

D: OK, so you're not bringing up any sputum with your cough?

P: No, maybe maybe a tiny bit, but I kinda do that like anyways.

D: OK. Uh, and have you coughed up any blood?

P: No.

D: OK, and um, have you had any other symptoms that have went along with this difficulty breathing, um and cough?

P: Um I mean I've been, I don't have a thermometer at home, but I have felt like really hot. And. Just this morning, like my husband, you know he was trying to make sure I was still eating and drinking a lot and I don't really feel like I am tasting my food all that well.

D: OK, so would you say that you have a loss of taste right now?

P: Um pretty yeah yeah, I'm pretty sure I couldn't really taste my breakfast.

D: OK. And how about your sense of smell?

P: Actually, yeah come to think of it, I don't. I don't think I've really been smelling much.

D: OK, so you're not able to smell either. Do you feel like your nose is congested or are really runny?

P: It's not, it's not particularly congested or anything.

D: OK. But still have had these changes in taste and smell.

P: Mmmm

D: Um OK and we will check your temperature as well to see if we can, if there is a documented fever. Have you had any night sweats?

P: Whats that?

D: So generally, patients would will say that their sheets are soaked and it will wake them up sometimes because it's uncomfortable.

P: Oh no, I haven't had that.

D: OK, how about any chills? So it could be like when you kind of shaking in your in your bed.

P: No, not really. Just just like there really. I think, like fever, I think fevers.

D: OK, and have over the last several months. Have you had any weight loss?

P: No, I think I've been pretty well the same.

D: OK, an with um the change in taste, how has your appetite been?

P: Well, I mean that was just this morning that I noticed that. Um, before that, I think I was eating like pretty OK.

D: OK, and have you felt as though your heart was racing at any point?

P: No.

D: OK. Uh, any dizziness or feeling lightheaded?

P: Oh no, I don't think so.

D: OK. And any abdominal pain?

P: No.

D: How about any nausea or vomiting?

P: No.

D: OK, have you had any diarrhea or constipation?

P: Maybe maybe a little diarrhea. Oh but I didn't know if that was just something I ate or what.

D: OK, so when did the diarrhea start

P: Like yesterday. yesterday.

D: OK, and and approximately how many times did you go to the bathroom, would you say?

P: So probably like twice where it was really loose.

D: OK, and did you notice any blood?

P: No.

D: OK um, has that happened again today?

P: Oh no, I didn't go today.

D: OK. And have you had any urinary problems like painful urination or needing to go really often?

P: No.

D: OK and then uh, have you had any headaches?

P: Come to think of it a little bit, I just thought I was like it was maybe because I was tired. But yeah, I've had headaches.

D: OK, have you had headaches like this in the past?

P: Um, I mean only when there is like reasons for it, like being really overtired or. Uh. Yeah.

D: OK, does this feel similar to any of those times?

P: Let me know it's hard to say like I am tired so. Yeah, I think so.

D: OK, would you say this was the worst headache of your life or a kind of like a Thunder clap sensation?

P: No, nothing like that.

D: OK. And have you got any photo sensitivity or kind of sensitivity of your light or sensitivity to sound?

P: No.

D: OK. And next question would be. Have you have any any joint aches or muscle aches or general body aches?

P: I mean, I'm a little I feel like I haven't been moving as much. Feel a little sore. I thought it was maybe just 'cause I, you know, wasn't going for my long walks and my body was like getting tired and stiff. But yeah, I feel a bit achey when I come to think of it.

D: OK, and have you noticed any rashes or changes in your skin?

P: No.

D: OK, uh, and then I'm not sure if I asked, but did you have a sore throat?

P: Uh, no.

D: OK. Um and next just wanted to ask about your past health. Um is there anything you see a physician for regularly?

P: Just like the COPD.

D: OK.

P: My family doctor.

D: OK, and do you use inhalers for that?

P: Oh geez, I haven't seen my family doctor in awhile because of, the covid stuff. But I have an inhaler. Ah. That was probably like before covid that it was prescribed and then I ran out at some point and I haven't got it renewed.

D: OK, so. When was the last time you used an inhaler, a a week ago, a month ago?

P: I probably ran out like two months ago, but I wasn't using it every day. It was like one of those ones for like when you need it and, now, now this week I wish I would have had it.

D: OK, I see. So before like two months ago, how often would you say you were using it?

P: Oh, maybe once you're once a week.

D: OK um. And when what types of situations where you finding yourself needing to use it more often? Or rather where there any kind of triggers to those events?

P: Like if I if I say I took my dog for a walk and they kind of got away and I had to run a little like run a little bit. Usually I walk like pretty fast but if I have to run that would that would make it, would make me have to use it.

D: OK, so a lot more exertion than what you're able to do now it sounds like.

P: Yeah, like heavier exercise.

D: I see, and any other medications like prescribed or over the counter that you take?

P: No, that was it.

D: Alright, and have you had any surgeries before?

P: I had my appendix out when I was in my 20s.

D: OK, and any allergies?

P: No.

D: OK, and um. Have you been anybody sorry, have you been around anybody who's been sick recently?

P: Well, we haven't really seen anyone because of the covid stuff so. It's just my my husband has someone, like has, a friend that comes over for them to the they watch like the sports games together like our friend lives alone. So that's really the only person that's been coming into our house and I don't. I don't know that I don't think he's been sick. But he he might have been around people that were sick.

D: OK, I see so he hasn't had any symptoms though?

P: Not that I know of. We haven't heard from him in a few days though.

D: OK, and how was your husband been?

P: Oh, he's been well. He said he like he had a bit of a scratchy throat, but I don't think he's he hasn't really felt sick. I don't think.

D: OK yeah, and do you live with anybody else or is it just you and your husband?

P: Just the two of us and our dog.

D: OK, and, uh, do you smoke cigarettes?

P: Yeah, I've tried to stop but I I smoke like a pack a day.

D: OK, we can talk maybe about quitting if you're interested later on in the appointment or at another time at a follow up.

P: Sure, sure.

D: OK, and do you drink alcohol?

P: Like maybe like a glass of wine on a Friday.

D: OK, so very it sounds occasionally, maybe a drink a week?

P: Yeah, something like that.

D: Alright, and um do you smoke marijuana?

P: No.

D: OK alright, how about that use like any like edibles or anything like that?

P: No nothing like that.

D: OK and then how about any recreational drugs?

P: Um like what?

D: Like things like cocaine, crystal meth, ecstasy.

P: No, no.

D: I See, OK, and Is anybody in your family had any heart conditions before?

P: My dad had like high blood pressure.

D: OK, anybody ever heard attack?

P: No, not that I know of.

D: OK, and anybody in the family have lung conditions in the past?

P: Uh, no.

D: OK, at any cancers that run in the family?

P: No.

D: Alright, so was there anything else that um you think I should know today that maybe I didn't ask about?

P: I just feel tired. I just feel like really tired.

D: OK, certainly that can be part of a kind of what how you're feeling and right now with the situation with the pandemic, COVID-19 is definitely pne thing that will be testing for today.

P: Do you think I have COVID?

D: It's very possible because of how general the symptoms are for covid, and so it's something that we want to test for. That being said, you could have another viral illness, such as the common cold like adenovirus. Or you could have a bacterial infection that's not Covid really related at all Or this could be an exacerbation of your COPD and maybe We need we need to just titrate your inhaler so we'll need to. Just run some lab work and do the PCR nasal swab as part of the work up an we will see what some of those investigations show.

P: Oh geez, OK.

D: OK, it's all in the meantime. You'll need to quarantine for 14 days. And if the results are positive, well after note notified public health so that the appropriate contact tracing can be made. But we'll get the investigation started now.

P: OK, thanks doc.

D: Alright, you're welcome.


D: May I just begin with asking you what brought you in here today?

P: Sure, um, I've been experiencing some issues breathing, um and just a lot of coughing over the past year or so.

D: OK. And is your cough, has it been a wet cough or a dry cough?

P: Uh, but it's been a wet cough.

D: OK. You mentioned it started over a year?

P: Well, about, about 8 months.

D: 8 months. And has it been getting worse at all?

P: Yeah, I think it's been getting worse.

D: OK. And so it's been a wet cough. Do you release any kind of like phlegm or sputum?

P: Um, yeah, it's usually clear, but sometimes it can look yellow or green.

D: OK, and how, how much would you say you produce every day?

P: Um, like um, in total per day?

D: Or just maybe every time you cough.

P: Every time I cough maybe like the size of my thumbprint.

D: OK, and have you notice at all coughing up any blood?

P: No.

D: Is the blood ever mixed into the phlegm?

P: No.

D: OK. And uh, has it been constant coughing? Or does it come and go over the last eight months?

P: Um, it comes and goes, but there, there it's always like I have a tickle in my throat or something.

D: OK, and when it first started, had anything changed in your life? Uh, had you move to a new place or started smoking or anything like that?

P: No.

D: No. OK. Is there anything you do that makes the coughing or shortness of breath worse?

P: Um, I guess walking.

D: Walking? Is there anything that makes it better at all?

P: Just resting.

D: Just resting, OK. How much can you walk or run until you feel the coughing or shortness of breath?

P: About like 200 meters.

D: OK. And has this ever happened to you before the eight months?

P: No. Actually, I get wheezy because I have asthma, but it doesn't, it's not as bad as this.

D: OK. And, um how often are you coughing, are you coughing throughout the day? Or is it more so during the day and then or more at night?

P: Uh, it's just kind of always there, um throughout the day.

D: OK. And do you have any other symptoms besides the difficulty breathing and the cough? Do you have a sore throat, runny nose, dizziness, anything like that?

P: No.

D: OK, so just the difficulty breathing and the cough?

P: Yeah.

D: Do you get any chest pain at all?

P: No chest pain.

D: Great, have you traveled anywhere outside of the country recently?

P: Uh, no, no.

D: Any headaches, nausea or vomiting?

P: No.

D: Any fever, chills or night sweats?

P: No.

D: Do you feel increasingly fatigued throughout the day?

P: Yeah, I guess coughing a lot makes me tired.

D: OK, do you ever feel that your heart is racing or you have any kind of chest pain?

P: No.

D: Have you noticed any issues urinating?

P: No.

D: Any changes in your bowel movements, any constipation or diarrhea?

P: No.

D: Any issues with your sleep or appetite?

P: Uh, no.

D: Any significant changes in your weight?

P: No.

D: Have you had any recent infections that you know of?

P: Not that I know of.

D: Any antibiotics that you've had to use for any infections?

P: No.

D: Um, do you think you have had any exposure to tuberculosis in the past?

P: No.

D: And do you have exposure to fumes or dust or animals or pets in your work or home environment?

P: I have a bird.

D: A bird? And when did you get the bird?

P: Like five years ago.

D: OK, but no issues before the eight months?

P: No.

D: OK. In terms of your overall health, do you have any past medical conditions? You mentioned asthma, but anything else like diabetes, high blood pressure?

P: I have type 2 diabetes and high blood pressure.

D: OK. And or do you take any medications for those conditions?

P: No, it's just being controlled by diet.

D: OK, any medications for any other reasons?

P: I take some vitamin D tablets.

D: OK, any allergies, environmental or to medications?

P: No.

D: OK, have you ever been hospitalized?

P: No.

D: Any ill contacts near you at home or work?

P: No.

D: Any previous surgeries?

P: No previous surgeries.

D: OK, do you have any family history of asthma or any other lung condition or any cancers?

P: No lung conditions or cancers.

D: OK. And currently, do you work?

P: I do.

D: And where do you work?

P: I work as an accountant.

D: OK. And do you currently live in an apartment or a house?

P: In an apartment.

D: OK. And do you live by yourself or do you live with anyone else?

P: Just by myself.

D: OK. Any new changes to your house uhm, any new carpets or anything like that? Or have you moved into a new new place recently?

P: No.

D: OK, do you use any recreational drugs like marijuana?

P: No, I smoked when I was younger, but not anymore.

D: OK, and do you smoke cigarettes?

P: I do.

D: OK, and how much would you say you smoke on an average day?

P: Uhm, about half a pack a day.

D: OK, and how long have you been smoking for?

P: Since I was 18.

D: OK. And you drink alcohol?

P: Uhm, sometimes.

D: And how often would you say on an average week, how many drinks of alcohol would you say you have?

P: Uhm, maybe 2 glasses of wine a week.

D: OK. And in terms of your diet and exercise, would you say you get 3 meals a day? Well balance, well balanced diet?

P: Um, yeah, I'd say so.

D: OK, and lastly, in terms of exercise, would you say you're fairly active throughout the week?

P: Uhm, yep.

D: And what kind of things do you do for activity?

P: Um, I take walks when I can. Um, before this whole shortness of breath thing, I used to ride my bike.

D: OK.


D: What brings you in here today?

P: Um, I just I've had a cough and I've had a sore throat for the past two days and I was just worried that I might have COVID so I thought I'd come in. Just to make sure that everything's OK.

D: OK, well that's a good idea that you came in, so it's been happening for the last two days. Did you start having the cough first or the sore throat or both around the same time?

P: It started with a sore throat two nights ago and then it got worse in the morning when I woke up and then I developed the cough, like about a day ago, a day and a half.

D: OK and can you describe your cough? Is it a wet cough or a dry cough?

P: It's a dry cough.

D: OK, are you having any kind of? Are you bringing up any blood or sputum at all?

P: No.

D: No OK. And, uh. So this started 2 days ago. Is it constant, are your symptoms constant? Or they come and go?

P: No, they're not constant. They kind of come and go.

D: OK, and do they occur when you're exerting yourself at all or it can happen it? Or do they happen at some point during the day in the morning or night, or just randomly?

P: It's pretty random.

D: Okay. Are you symptom getting any better or worse?

P: Uhm? Maybe a little worse. I kind of feel like I'm also, um, I'm now having like a, a runny nose.

D: A runny nose as well? OK, when did that start?

P: Uhm, maybe like I don't know just now even, like an hour or two ago.

D: OK, uhm have you had any recent exposure to anyone that's been sick recently at all?

P: Uhm? Maybe. I, I work at a hospital. Um, but I'm always maintaining, social distancing and I try to be very careful.

D: OK, and uh. Do you have you tried any medications over the counter to help with these symptoms?

P: No.

D: OK. Do you have any other symptoms like. Shortness of breath, chest pain, dizziness, or anything like that?

P: No.

D: No. Okay. And the sore throat are you having trouble or pain while swallowing any food?

P: It's not that bad.

D: Not that bad.

P: It's just irritation in my throat.

D: OK. Any hoarseness in your voice at all?

P: No.

D: Well, OK. Have you traveled at all recently utside of the province?

P: No.

D: Any headaches?

P: No.

D: Any nausea, vomiting?

P: No.

D: Any fevers or chills?

P: Now I know.

D: No OK. Any fatigue or malaise?

P: Maybe a little bit. It's not too bad.

D: OK, any muscle aches at all?

P: Uhm? Yeah, little bit.

D: Okay, and when did that start?

P: Maybe two days ago?

D: OK, and is it just all over your body or in certain locations?

P: It's all over.

D: Have you tried any pain medications?

P: Uhm no, no I haven't.

D: OK. Any changes in your bowel movement at all like Constipation or diarrhea?

P: No.

D: Um, any changes in your appetite?

P: No.

D: OK, have you lost any significant weight recently?

P: Uh, no.

D: OK. Do you have any past medical conditions that you've been diagnosed with?

P: Um, no, I'm pretty healthy.

D: OK. Any allergies to medication?

P: No.

D: Any environmental allergy?

P: No.

D: OK, any previous, so sorry? Are you taking any medications at all right now?

P: Uhm? Um, I'm not, no.

D: Any past hospitalizations or surgeries?

P: Um, no.

D: No. OK, and any family history of any lung or heart condition.

P: Just high blood pressure. My mom has it.

D: OK. Uhm, and currently, are you working?

P: I was working before the symptoms started.

D: OK, and what do you do for work?

P: I work as a custodian at the hospital.

D: OK, and so you've been isolating and have you gotten COVID swab test yet?

P: Uhm no I haven't.

D: OK, so yeah we can do that for you today after a physical, physical examination.

P: Sure.

D: Currently, right now, what's your living situation like?

P: I live alone.

D: OK, and do you live in like an apartment or house?

P: Apartment.

D: OK, and any new exposures at all in your house to dust, new, carpets, animals, anything like that?

P: No.

D: No, OK. And do you smoke?

P: I used to, I don't anymore. I I smoked when I was in high school. Maybe a couple times.

D: And do you smoke marijuana?

P: No.

D: Uh, any alcohol?

P: Um, once once a day, maybe one class of wine at night.

D: Yeah, so that's all the questions I had for you today. Do you have any questions or concerns?

P: No.

D: OK, so yeah, it seems like you've been having these symptoms for the last few days. They seem kind of like viral in nature with your dry cough and runny nose, sore throat. And sometimes with these viral illnesses, it may take some time for the symptoms to go away, especially the cough. So today we will do a COVID swab test for you today, as a lot of the symptoms overlap and you will receive the result in the next one to two days and be contacted by public health for further instructions. As for management, I think you can take over the counter medications like Tylenol cold, drink lots of fluids and stay hydrated. And if those if your symptoms worsen at all, you can contact us again.

P: Sure, thank you.

D: Welcome, take care.


D: What brings you in?

P: Yeah, so I just came in because I've been having this cough that's getting worse over the last uh one and a half week and uh, I've also just recently in the last few days been getting some shortness of breath. Um and I also noticed uh my bowel movements have changed a little bit as well over the last week.

D: OK, so yeah, let's break this down. The cough, when did that start?

P: The cough, I think it started uh probably like around 10 days ago.

D: 10 days ago, OK, and how about the shortness of breath?

P: That just started in the last uh I think 3 days.

D: OK, and then the the bowel bowel changes, when did that start?

P: Yes, I think it also started in like, I would say, for the last three days I've been getting uh diarrhea.

D: OK OK, so let's go back to the cough, is it constant or um is it triggered by certain things like the cold air, dust, um you know, um, certain times of the day, like morning, evening?

P: Um, I would say it's pretty pretty constant since the last like 10 days, uh it's, there's no real pattern to it, and I've mostly just been inside my house. I don't think there are any triggers or I don't own any pets or anything like that, no new rugs, like uh, no no new changes really in my house.

D: OK, OK and um have you tried anything to make it better?

P: Um, no, not really. I I've done some uh home remedies like trying to do one of those steam steam masks and see if that helps, but it didn't really do anything.

D: OK. Um and how about um the quality of that cough? Is it, does it sound harsh?

P: Um, yeah I would say it's getting a little bit harsh. It's more just like, I'm not bringing anything up, it's more like a dry cough um, but yeah, I would say it's getting worse, definitely.

D: OK. Um, is it a dry cough then, or are you producing a little bit of sputum or blood or anything like that?

P: No, no, I haven't seen any blood at all and rarely do I bring like up some sputum, but like most of the time it's just a dry cough.

D: OK, it's a dry cough. Um and would you say the cough's getting worse?

P: Yeah, I'd definitely say in the last um three to four days I've been just coughing nonstop, it's very irritating.

D: Yeah, have you experienced anything like this before?

P: Um, probably a few years ago, I think I caught the flu or something and got really sick with a fever and just a lot of coughing. But since then, nothing else.

D: OK. Um the shortness of breath, 1 to 10, 10 being the worst, how bad is it?

P: Uh probably like a five. It kind of just started out with uh, three days ago, was kind of like I just
couldn't take deep breaths like I noticed that my breathing was getting a little bit more more shallow and now it's, especially when I'm coughing, it's like I really have to sit down and catch my breath.

D: Yeah, um does anything make the shortness of breath worse? Like I guess um you know exertion, uh laying down, anything like that?

P: Um, not really. Maybe like sitting down helps sometimes, but even when I'm sitting down I'm still coughing.

D: OK. OK and um do you have any wheeziness?

P: No, I don't think so.

D: OK, any chest pain?

P: Um, maybe from all the coughing, sometimes I feel like there's some pain there, but it's not not anything that's too painful.

D: OK, um do you feel like your heart's racing at all?

P: Uh no, not really.

D: OK. Um have you noticed any swelling in your limbs?

P: No, I didn't notice anything like that.

D: OK, how about um pain in your calves when you walk a few blocks?

P: No, I've been fine that way.

D: OK. Dizziness or fainting spells?

P: Uh no, not really, I I thought maybe with the shortness of breath that would happen, but like so far that hasn't happened to me.

P: OK, any fevers or chills?

D: Uh no I, maybe like a few chills, like I'm not sure actually, it was hard to tell, but I haven't had any fevers.

P: OK, we'll take your temperature today just to make sure. Um any weight loss over the past few weeks?

D: Uh no, probably weight gain.

P: OK, any changes in your hair, nails, or skin, like rashes?

P: Uh, no, I haven't noticed anything like that.

D: OK, any changes in your vision or hearing?

P: Uh no, no, that that's all been fine.

D: How about um loss of smell or taste?

P: No, I haven't had uh, I think my taste and smell are still pretty good. No, no issues there.

D: OK, um have you had a runny nose or stuffy nose?

P: No, no, no no congestion really.

D: OK, and um have you had a sore throat at all?

P: No, no sore throat.

D: OK. Um any issues swallowing food?

P: No.

D: No, changes in your appetite?

P: Maybe just a little bit, like I don't really feel like eating when I'm coughing all the time, but other than that, no, not really.

D: OK. How about nausea or vomiting?

P: No, nothing like that.

D: OK um constipation?

P: No, diarrhea.

D: Diarrhea, right. Um how often are you having a bowel movement right now?

P: I would say uh like I've been going, probably more than eight times a day, probably in the last few days like 10 times a day.

D: Oh wow, OK, and each time are you producing a lot of stool, or is it just a little bit each time?

P: Like a little bit, but it's mostly liquidy.

D: OK. Any solids at all? Like is it semi solid at all?

P: Um maybe a little bit, but mostly it's just liquid.

D: OK, um any blood in the stool?

P: No, I've been checking uh no, I didn't notice any blood or change in colour. It's mainly just um liquid diarrhea.

D: OK, any changes in your urine?

P: No.

D: No, OK, um any confusion or memory loss?

P: No, not that I know of.

D: OK, um how about muscle aches or joint pains?

P: No, nothing like that.

D: OK, and are you otherwise healthy or do you have any long uh standing medical conditions?

P: Uh, so I do have diabetes and high blood pressure.

D: OK, do you take any medications for those conditions?

P: Yeah, so for diabetes I'm taking this medication called uh like I think metformin and then for the blood pressure, uh I think it's, I forgot the name, I think it's something like um ramipril or something like that.

D: Yep, OK, and you're taking that um as directed, right?

P: Yeah, I've been taking that regularly and my blood pressure, I've been measuring, it's been pretty steady, no changes.

D: OK, that's good. Have you had any hospitalizations or surgeries in the past?

P: I did have my appendix removed, probably in my 20s, but uh that was the only thing.

D: OK, um and do you have any allergies?

P: No, not not really.

D: OK. Are you up to date with all your immunizations?

P: Yep.

D: OK. Are you on any other medications besides the ramipril and metformin?

P: Just uh like multi vitamins for men over 50.

D: OK, OK. Um any family history of heart conditions or lung conditions that you know of?

P: Um yeah, so my family, like diabetes is pretty big, it runs in the family and uh my father in his 60s uh like died from a heart attack. Um other than that, not anything else I can think of, no.

D: OK, any cancers in their family?

P: Uh no, I don't think so.

D: OK, do you smoke?

P: I used to, I I quit probably five years ago, but before that I used to smoke probably a pack a day for more than 20 years.

D: Oh OK, well good job for cutting down and quitting, um.

P: Yeah.

D: Yeah, um do you do marijuana at all?

P: No, no no no drugs.

D: Any other recreational drugs? You said no, right?

P: Yeah no, no, I don't do any drugs.

D: OK, um do you drink alcohol?

P: Yeah, I probably have maybe um some whiskey maybe a couple times a week.

D: OK. Um and where do you live right now?

P: Uh, so yeah, I just live in the city in London uh in an apartment with my, just wife, my wife.

D: OK, um is she also sick or is she OK?

P: No, she's been completely fine, and I've been kind of isolating myself from her over the last week.

D: OK, well that's good and that's smart, um just because you don't know what you have, right?

P: Mhmm.

D: Yeah OK, do, can you think of any other sick contacts that you may have had over the past one or two weeks or even three weeks?

P: Um I go to the grocery store, then I go to work, I haven't noticed anyone being sick at work, but you know, you never know like who comes in asymptomatic and like they might be carrying it, with this
virus like mainly I'm worried about covid and you know just how fast that's spreading everywhere.

D: Yeah, for sure. Um yeah, for sure, have you traveled to anywhere recently?

P: No, uh we've been in Canada, Ontario, haven't left to go anywhere.

D: OK. OK, well those are all the questions that I had for you. Did you have any questions or did you have any concerns, anything that you wanted to discuss today?

P: Yeah no, I just uh was wondering if I can get the covid test, that would just, I wanted to make sure I don't give anyone covid if I do have it.

D: Yeah, for sure, I think that's a good idea. Um so, and it's definitely something that we need to rule out, so we'll do a covid swab today um and you'll hear back within 24 to 48 hours, um but in the mean time, regardless of whether you actually have covid or not, because your symptoms overlap with covid, um it's good to isolate for 14 days and that includes trying to isolate from your wife as well if possible, and public health should be in touch if it's positive uh to do contact tracing. Um and if it's not covid, it's probably another viral illness that's going around at this time of year. Uh if your symptoms get worse, um you know you're having neurological symptoms or or if your fever gets really high, or you're having a lot of trouble breathing, then you should go see the ER. How does that sound?

P: My, if my breathing gets worse uh I'll just go to the emergency Department?

D: Yes, please do.

P: OK, sounds good.

D: Alright, take care.

P: You too, thank you.


D: I understand that you've been having some diarrhea. Can you tell me a little bit about that?

P: Yeah, sure I had, I've been having diarrhea for the past three to four days, and it's been pretty bad. I couldn't go, uh I couldn't go to my classes, had to skip because it was just it was just embarrassing.

D: OK, I'm sorry to hear that. Uh, have you ever experienced something like this before?

P: Um, have I experienced something like this before? Uhm no, I don't think so.

D: OK. And over the three or four days, have your stools all been loose? Or have you had some solid ones in between?

P: I think they've mostly been loose. I think they've all been loose actually, if I think about it.

D: OK, and how many times a day have you been having episodes of diarrhea?

P: Oh my god, I have I've lost count. I'm going every every hour.

D: OK, every hour. OK, and then you notice any changes in the color of your stool?

P: No, it's brown.

D: OK. Any blood in your stool that you've noticed?

P: Um not really. I don't think so. I don't look that much to be honest.

D: OK, um have you noticed any any pain associated with it?

P: Well, I didn't start off with pain, but I I I do have a bit of a cramp now since yesterday. It's just it hurts. Yeah, it hurts sometimes, it comes and goes.

D: OK, and do you feel that when it, do you feel that you still have control over like releasing it to like does it come on and you don't even notice that it has happened or you still are able to kind of have a warning before you get to the toilet?

P: Uh no I do get a warning, but it's just I I do need to get to the toilet really fast, yeah.

D: OK, and before this happened, have you noticed, have you, is there anything that you've done differently that you've been eating differently, or any other changes that have happened in your life recently?

P: Um, I I did go to um, I did go to a new restaurant 5 days ago.

D: OK, what did you have there?

P: Um  I I just got some rice with chicken Manchurian, it was a nice little Chinese restaurant, and yeah.

D: Did anyone else have the same thing that you did that you were with?

P: Um, no not really, I went with my friend and I haven't really, haven't talked to her about this. I never really thought that these were related, that this was related to that.

D: And then it's, you know, absolutely, potentially not like, maybe not. It could possibly be so not to not to worry you about that. We just like to get an idea of kind of the whole picture of what you're coming in with. So in terms of the last three to four days, have you experienced any nausea or vomiting?

P: Yeah yeah, I have actually, but it's not been as bad as the diarrhea. I didn't even yeah, I didn't, I wasn't even thinking about that. Yeah, I I did vomit, I think twice yesterday.

D: OK, have you noticed any blood in the vomit?

P: No, it's just watery.

D: And are you nauseated all the time, or is it kind of on and off?

P: It's on and off.

D: OK, have you taken any any over the counter medicine or anything to help?

P: Uh, not really. I was just trying to drink a lot of water, 'cause I I know that I can get dehydrated so just drinking lots of water.

D: OK, well that's good to hear. Have you have you been eating normally or have you not been eating as much as you regularly do?

P: I have been eating less specially since yesterday when I had my these abdominal cramps started. I just don't feel like eating.

D: OK. Is there anything that has been making it worse?

P: Making what worse?

D: Just in general, like is there anything that you're finding makes your nausea or your diarrhea come on?

P: Not really, I don't think so.

D: Do you notice any changes to your urine or any discomfort when going to the bathroom?

P: No.

D: Have you traveled anywhere recently?

P: No.

D: OK, and have you noticed any fever or chills in the last few days?

P: Um, I've just been feeling really tired and and, I don't know, maybe I haven't checked my checked my temperature.

D: OK. Have you noticed any rashes or changes in your skin?

P: No.

D: OK. Have you noticed any major changes to your weight, I know that you might not weigh yourself everyday, but anything that jumps out to you?

P: I actually haven't weighed myself in the past five days, so I don't, I don't know.

D: OK. OK, I'm I'm just gonna jump to you and your general history. Do you have any history of problems with your digestive system?

P: No.

D: OK. Do you have any chronic conditions that you see a family doctor for regularly?

P: I have asthma.

D: OK. Do you take any medication?

P: Yeah, I've got some puffers that my family doc gave me.

D: OK. Nothing else?

P: No, that's it.

D: Do you have any allergies?

P: Um, no I don't.

D: Have you (unclear speech due to connection issues)?

P: I'm sorry, can you say that again?

D: Have you ever been hospitalized in the past?

P: Um? I had my wisdom teeth removed. But no, I like I wasn't hospitalized, no.

D: Have you been in contact with anyone recently that's been sick?

P: Nope, I don't think so.

D: OK. What is your living situation right now? You said you're a student?

P: I am.

D: OK, and do you live, do you live on your own, with family, with roommates?

P: I live with two roommates.

D: Do you drink alcohol?

P: Um, sometimes.

D: OK, how how many drinks per week would you say?

P: I might have like a glass or two on the weekends.

D: OK, do you smoke?

P: No.

D: OK, do you use any other substances?

P: No.

D: OK, and what would you eat on a regular day typically, what would your typical diet be?

P: Oh gosh, um well, I like to have oatmeal for breakfast. I usually make something quick for lunch, maybe like a salad, and then I might have my, I'll probably just like eat out at night, maybe get like a burger or fries or something.

D: OK. Well, and I just wanted to jump over to ask you about your family history. Does anyone in your family have any history of digestive problems, or um abdominal problems, abdominal surgery?

P: My brother had appendicitis when he was young. Um, my mom has had a hysterectomy if that counts. Yeah, nothing else.

D: OK. OK, thank you for sharing that with me. So I think that's everything that I wanted to ask you for today.


D: I just wanted to start with what brings you here today to the family clinic?

P: Hi, this morning I read after I woke up by I coughed up some phlegm and there was some blood in it and it it totally scared me.

D: OK, and was this the first time that happened?

P: Uhm, yeah, I've never I never noticed blood in my sputum before.

D: OK, but have you been coughing recently?

P: Uh yeah, I have, uh, had a cough recently leading up to this.

D: OK, and how long have you had the cough for?

P: Uhm, I've had it for uhm, yeah, about about four weeks.

D: Wow, four weeks. OK. Do you know if you did anything prior to that, any new exposures or being around someone ill like anything like that that might have caused your cough?

P: Yeah, I was just down in a, I went to Haiti on a on a trip for a, for a volunteer program with my school and I don't know I definitely notice there is a lot of people down there coughing.

D: OK, and were you at all living like close quarters or were you crammed into like like smaller spaces at all when you were there?

P: Yeah, we were kind of like living with the locals while we while we were there. It was part of the experience for volunteering. I was there for almost two months as part of, part of my my summer break through University.

D: OK, and did you notice, uh, at all any potential exposures to tuberculosis? Anyone there that had tuberculosis? Or found out later?

P: Yeah, there were definitely some people around that I heard of who who mentioned tuberculosis, but I don't know if anybody specifically who had it.

D: OK. And the cough that you've been having for the last four weeks at, is it like a wet cough? Are you producing any sputum or phlegm, or is it more of a dry cough?

P: Uh, I have been producing some phlegm, um, but it's been just kind of white, yellowish.

D: Up until this morning?

P: Yeah or moreso clear actually, up until today where I saw some blood.

D: OK. And how much blood was in the phlegm? Was it like a significant amount it filled the whole production or just little streaks?

P: Um it was pretty red. It, ah, yeah it was bright red and it was covering the, the issue.

D: OK and have you had any similar episodes before?

P: I've never brought up blood before.

D: And after this morning, was that the only time you had that or did you did it recur at all?

P: Um, it was just that time just this morning on the tissue and then a little bit in the toilet and it looked like a lot in the in the water.

D: OK, I see and how often are you coughing in like an average day? Are you coughing throughout the day or does it come and go?

P: Uhm, it's been pretty severe through throughout the day. I've been just coughing or coughing a ton.

D: OK, anything that makes your coughing go away or makes it worse at all?

P: Not-nothing seems to help. I've tried various over the counter medications and and stuff for, for cough and nothing has seemed to help it.

D: OK, and are you having any other symptoms at all, like shortness of breath, sore throat, runny nose, anything like that?

P: Uhm, nothing like like that. I mean the back of my throat, might feel a little itchy from the coughing, but not really sure.

D: OK. Are you having any headaches or nausea or vomiting?

P: Nothing like, well, a little bit of nausea maybe, but no vomiting.

D: OK. How often you getting nausea?

P: Uh, it's coming after like if I'm having a really big cough, coughing fit I could feel a little nauseous after but it doesn't last very long.

D: OK, are you having any fevers or chills?

P: Yeah, I've been having ah, so fevers throughout the day, but feeling really hot, and and really sweaty at night.

D: OK, how often are you getting night sweats?

P: Uhm, also a few times this past week, I've what woke up soaked.

D: OK. And have you at all measured when you felt, measured your temperature when you felt like these chills and night sweats?

P: No, I haven't measured my temperature yet.

D: OK. Have you noticed at all, uh, any increased fatigue throughout the day?

P: Yeah, but I've definitely been more more tired. I haven't been able to concentrate on, umm, on my schoolwork.

D: OK. And, um, have you been having any shortness of breath?

P: Just after the, like coughing really, but otherwise, ah, no.

D: Any chest pain?

P: No chest pain.

D: Any feeling that your heart is racing?

P: No, nothing like that.

D: OK, any swelling in your limbs at all?

P: No.

D: Ok. Any loss of sense of taste or smell?

P: Uh, no, nothing like that.

D: OK, any changes in your bowel movements?

P: Um, no.

D: OK, any changes in your urination?

P: No.

D: OK, any changes at all in your sleep?

P: Uhm, just been, well, I haven't been sleeping as well, waking up all sweaty and the cough is kept me up a little bit too.

D: OK, any changes in your appetite?

P: Uh, no, I've been eating OK.

D: Have you noticed at all any weight loss over the last few months?

P: Yeah, I think I'm down like 15 pounds since the summer time, which is great.

D: OK, have you tried to lose weight at all or is it just been completely unintentional?

P: Uh, well I, I mean my, my appendix was taken out a few months ago and so I guess after that I, well, maybe wasn't eating and eating as much, but I mean I wasn't really trying to lose weight.

D: OK, and have you had any recent exposure to any fumes or dust or animals?

P: Uh, no, my my parents have a dog at home, but I've been away at school, so.

D: OK. OK, uh, in terms of your overall health, have you been diagnosed with any medical conditions before?

P: Uh, no, I'm uh, healthy.

D: So like no asthma or anything like that?

P: No, nothing like that.

D: OK, are you on any medications currently?

P: Uh. Yeah, I take an oral contraceptive pill.

D: OK um, and when did you start that?

P: Probably about five years ago.

D: OK. Do you have any allergies, to any medications or any environmental allergies at all?

P: Uh, yeah, I think Septra, gives me a rash.

D: OK. Um, any previous hospitalizations?

P: No, I've never been in the hospital before.

D: OK, any previous surgery? So you said you had the appendix removed but anything else?

P: Uh, no the appendix was the only thing.

D: OK. Any family history of asthma or any lung conditions? Any cancers that run in the family?

P: Um, yeah but well, my grandfather had lung cancer, but he smoked for his entire life. And my mom has had diabetes for quite some time, but no, no lung problems.

D: OK, any heart attacks in the family or any autoimmune conditions?

P: No.

D: OK, and currently what is your living situation like?

P: So I live with uh, four roommates here going to school.

D: OK, and so do you work right now or you just a student right now?

P: Just a student.

D: OK. And currently do you smoke?

P: Uhm, I'mm smoke maybe maybe socially so, maybe a pack of cigarettes a week at the at the most.

D: OK. And any recreational drug use like marijuana?

P: Uh, yeah I'll smoke one or two joints on on the weekend with friends socially.

D: OK yeah, so yeah. This uh, the smoking marijuana or cigarettes make your symptoms worse at all?

P: Uhm, it depends. Yeah, sometimes I can. It can bring on some more coughing.

D: Yeah, so yeah, we always recommend cutting down or quitting smoking whenever, whenever we see patients who are smoking, especially like, you're fairly young. And you know your grandfather had history of lung cancer with smoking throughout the year. So as early as we can quit smoking, the better for the long term health of your lungs, but whenever you're thinking of quitting, or if you want any more resources about quitting, just let me know. We can set up a separate appointment for that.

P: OK, that that sounds good. Yeah, maybe maybe next appointment we can talk about that.

D: OK, sounds good. Um. Any, uh, so no recreational, so just besides marijuana. Any other recreational drugs like cocaine or crystal meth, anything of that sort?

P: Ah, no. Well, sometimes I at parties maybe a few times a year with friends will use ecstasy or something like that, but that's only a few times a year.

D: OK. Uh, and any alcohol?

P: Yeah, I'll have a few drinks on the weekend with with friends usually. Like rum or beer.

D: OK. Yeah, so this is all the questions I had for you today. Any, any questions or concerns or any ideas of what you think this might be?

P: Uhm, I don't know. I'm really concerned about the the blood that I brought up like I mean is this cancer or, uh, uh tuberculosis like one of those tuberculosis infections that I heard about while I was away?

D: Yeah, so definitely, a cancer is pretty unlikely because you're fairly young and you've just recently started smoking, but one of the things that we're concerned about is your recent travel history being in close quarters. So definitely we need to get a chest X-Ray and we can even do a sputum culture to test for tuberculosis. And then based on the results, we might have to start you on like a whole antibiotic regiment if it does come back as tuberculosis. Yeah, we'll, we'll, we'll get those investigations done first and then we'll go from there.

P: OK, thank you.

D: We'll also get some blood work done as well, so that'll be done before your next appointment.

P: Alright, that sounds good. Thank you.

D: You're welcome.


D: What brings you in?

P: Hi I just came in today I have been having, just been feeling really sick over the last three or four days. It started with just like a headache and cough four days ago and then I started getting some nausea and vomiting few days back as well as diarrhea.

D: OK, so the headache and cough started first you said right?

P: Yeah.

D: OK, let's talk about the headache first that came on four days ago. Has it been persistent or does it come and go?

P: It's been pretty persistent. Besides, when I take some Tylenol.

D: OK, and does anything make it better or worse?

P: Just a Tylenol, nothing really, yeah, it's pretty constant,

D: OK, and have a an and sorry where exactly is it is it on it's like at the top of your head, temples, forehead?

P: It's kind of like my forehead in the top of my head on both sides.

D: OK and does it radiate your neck or anywhere else?

P: No, I think it’s, it doesn't go to my neck or anywhere else.

D: OK, and do you have neck stiffness or neck pain with that?

P: No, not really.

D: And one to ten, ten being the worst pain you've ever had, how bad is it?

P: Uh the headache, probably like 7.

D: OK. Uhm and timeline wise, has it gotten worse over the past four days?

P: It's kind of stayed around the same, actually.

D: OK, OK, and have you ever had a headache like this in the past?

P: Not really, I don't really get too many headaches

D: OK so this isn't you. Alright And let's go on to the cough. The cough started around the same time you said, has that gotten better or worse over the past four days?

P: It's the cough is around the same as well.

D: OK, and is it a dry cough or are you breaking up any flem?

P: It's mostly a dry cough.

D: OK, so no sputum or blood?

P: No, no.

D: OK, good. Alright, and are you short of breath at all?

P: Uhm, no, not really,

D: No OK. And how about wheezing?

P: Uhm no, no wheezing.

D: OK. Only saying an. And any chest pain?

P: No.

D: No OK. And have you had any weight loss over the past few months?

P: No, I haven't.

D: Any fevers or chills?

P: No.

D: No OK, uhm how about fatigue?

P: I guess just a little bit tired over the last few days, but I don't know that's just just from the diarrhea and just being sick.

D: Um OK, and how about rashes?

P: No.

D: No, OK changes in your vision or hearing?

P: No.

D: Uh itchy eyes, discharge anything like that?

P: No, nothing like that.

D: About a stuffy or runny nose?

P: No, nothing like that.

D: OK, how about changes in your smell or taste?

P: Uhm smell I feel like a little bit. I've been kind of losing my smell over the last I would say one day.

D: OK, OK. Alright, and any dizziness or fainting spells?

P: No, nothing like that.

D: Confusion or memory loss?

P: No.

D: Uhm alright and joint pains or muscle aches?

P: Uh no.

D: Alright. You mentioned you also have had diarrhea. When did that start?

P: So probably like 2 days ago I started getting some liquid stools and I just had to go like probably five or six times a day. .

D: OK. Alright. And uhm are you noticing any blood in there?

P: No, I haven't seen any blood.

D: OK, do you feel dehydrated?

P: No, I've been trying to keep hydrated.

D: OK, good, any changes in your appetite?

P: Uh no.

D: No, any nausea or vomiting?

P: Yeah, I was having some. I'm having some nausea today, but I had some vomiting yesterday. I vomited two times.

D: OK. And are you throwing up any blood?

P: No.

D: What color is it?

P: Uhm it's usually I feel like whatever I eat. Yeah, contents, food contents.

D: OK, do you think anything triggered that episode of vomiting?

P: No, I haven't really ate anything new, I'm just in my house, yeah I I don't know what triggered it.

D: OK, alright any feelings of like, feeling like you're bloated or gassy?

P: Uhm, no. Nothing like that.

D: OK, any constipation?

P: No.

D: OK. Alright, and are you otherwise healthy or do you have any longstanding medical conditions?

P: No, I'm I'm pretty healthy. I don't really. I don't really even take any medications.

D: OK. And are you up to date with her immunizations?

P: Yep.

D: Uhm, do you have any allergies?

P: No, not that I know.

D: No, any family history of lung or heart conditions?

P: Uh, no, not that I know of.

D: OK, do you smoke?

P: No.

D: No, OK. How  about marijuana or yeah, how about marijuana? Do you either take edibles or smoke it?

P: I’ve tried a couple times but it was not really my thing.

D: OK. And how about other recreational drugs like cocaine, heroin and opioids?

P: No, nothing like that.

D: OK. Uhm and where do you currently live?

P: I live just in an apartment just in the city. So yeah, just by myself though.

D: OK, any like old carpets, dust, mold, asbestos, pets, anything that could be triggering your symptoms?

P: No, not really.

D: OK and have you been in contact with anyone sick recently?

P: No, I've been. And kind of. At home, the only places I maybe have been in contact with someone is maybe at work. In like the lunch room and things like that.

D: OK. OK and sorry, where do you work?

P: I work at a car dealership.

D: OK, OK. An any travel recently?

P: No.

D: OK, has anyone at your work been sick as well?

P: No, I haven't really noticed anyone being sick.

D: OK, OK, well those were the questions that I had for you. Did you have any questions of your own for me?

P: No, I I was just wondering what this can be.

D: Um yeah, so the first thing we want to rule out as covid because a lot of your symptoms overlap with those of covid, so we'll take a swab and you should get those results in about 24 to 48 hours. In the meantime, you should isolate for 14 days. And if your results are positive, public health will be in touch with you to do some contact tracing. But if it's not covid, it could be another viral illness that's going around this time of year that could be causing similar symptoms as well, but either way the management kind of is supportive, so making sure you're well hydrated, eating nutritious food, sleeping well, taking antipyretics like Tylenol for fever's if you get any. And you can also take Tylenol or anseads for muscle ache, joint pains, anything like that. Does that sound OK?

P: Yeah, that sounds good. Thank you.

D: OK. Great, no problem.


D: So what brings you in here today?

P: Um yeah, so I brought my 7 year old daughter here um because she's been coughing uh a lot over the past two weeks. Um she's she sounds wheezy and I'm not too sure what's going on with her so, she's been off school um 'cause they think it's Covid. Uh we got her swab, but because she still has symptoms she can't go back to school, so here she is.

D: OK, um and when did the cough start?

P: It started two weeks ago.

D: OK, and when did the wheezing start?

P: Um that started about the same time like I should I should mention she does have like episodes like this. Um she's had episodes like this for the past like 2 years uh but they usually go away in a couple of days. But this time it's it's taking a lot like a lot longer to go away.

D: OK, so it's been uh has been more than a week, you said?

P: Yeah, it's been close to two weeks now.

D: Two weeks, OK. And uh were these symptoms brought on by, are they usually brought on by any kind of like activities or can they come up just by themselves?

P: I find it's usually worse in the winter um and if she's like doing some sort of uh like extensive physical activity, so if she's like playing tag and she's running around a lot. Um or if she's like at her gym class and they're running.

D: OK, and the cough that she's having is it like a wet cough or is it a is it a dry cough?

P: It's a dry cough.

D: OK, and at all, is she bringing up any yellowish or white uh or green material or any blood at all?

P: Uhm, it's, no nothing like that.

D: OK, and are her symptoms uh constant or do they come and go?

P: Her symptoms I guess come and go, um yeah, they come and go.

D: OK, and how many days of school has she had to miss?

P: She's missed almost two weeks now.

D: Wow, OK um and when she's at home, is she is she like very tired, is she um?

P: Yeah, yeah, she's pretty tired out um, yeah, she's pretty tired out, she's been doing a lot of like resting and uh you know watching TV. She's not really very active right now.

D: OK, uhm and have her symptom symptoms been getting worse over the last two weeks, or are they getting better at all?

P: Uh I can't, you know, I can't tell, it comes and goes so in that sense, it's been pretty constant. Um there hasn't been a day when she hasn't had these symptoms.

D: OK, and do they get worse at night at all or are they um the same throughout the day?

P: Uh yeah, now that I think about it, when she's laying down she does have a hard time.

D: OK. And is she having any other symptoms at all, like uh shortness of breath, um or sore throat?Anything like that?

P: Uh, no sore throat. She sounds wheezy, so she might have like some difficulty breathing, but she doesn't sound short of breath.

D: OK, and any kind of uh runny nose or any other symptoms at all?

P: No.

D: No, OK. Uh anything that helps her or makes her symptoms better?

P: Um no, nothing that we've tried.

D: Any recent uh travel at all?

P: No.

D: No, any fainting or dizziness spells?

P: No.

D: OK. Um, any uh fevers or chills?

P: No.

D: Any um changes in her bowel movements like any constipation, diarrhea?

P: No.

D: Any urinary problems?

P: No.

D: And any uh any kind of, do these symptoms wake her up at night at all?

P: Um no, no it doesn't wake her up at night. It just makes it hard for her to fall asleep.

D: I see. Is she getting enough sleep? Like how, how, how many hours would you say on average she's getting per day?

P: I'd say she's getting about 6 to 7 hours. She used to sleep about 8 hours before.

D: OK, um and is she having any changes in her appetite at all?

P: Um I don't think so, no.

D: No?

P: No.

D: Um any kind of changes in her weight at all over the past few months?

P: I haven't checked over the past month, but before that no, no changes.

D: No changes, OK. And um has she been, she had like a cold or anything like that recently?

P: No, not that I can think of.

D: OK, has she been around anyone that's been sick recently?

P: No.

D: OK. Um does she have any past history of any medical conditions at all?

P: Uh no, no, nothing like that.

D: OK and um does she have any uh allergies to any medications or any environmental allergies?

P: I think she might have some environmental allergies. We haven't gotten her officially tested though.

D: OK. And um has she had any previous hospitalizations or surgeries?

P: When she was a baby, when she was first born, she was hospitalized um for something about having like uh not fully developed lungs.

D: OK and uhm, was she premature at all? Or was she born after uh, at term?

P: She was slightly premature, I believe she's 34 weeks.

D: 34 weeks, OK. And um was it a vaginal delivery or was it a C-section?

P: Uh it was vaginal.

D: Vaginal, OK. Were there any uh complications during the pregnancy or after she was born? C

P: Um no complications after besides the hospitalization for the small lungs.

D: OK. And is there any family history of any lung conditions, heart conditions, or cancers?

P: Uh nope, nothing like that.

D: Has anyone in the family have, had any kind of asthma, eczema, anything like that?

P: Um no.

D: No, OK. Um so, and in terms of like at school, are there any kind of complaints uh and any um issues with her development over the last last few years?

P: No, nothing like that.

D: OK, so she's been growing well?

P: Yeah, she's been growing well. She's been gaining weight like a normal amount um and she's doing well, she was doing well at school.

D: OK. And um at home, uh what is the environment like?

P: Um she lives at home with both of us like um her mom and her dad, and uh she has a younger sibling who is 4 years old.

D: OK. And um does anyone smoke in the house at all?

P: Um no, not anymore.

D: OK, um how long ago uh did someone smoke?

P: Um it was, um so her dad used to smoke um and he stopped when she was like 3.

D: OK, that's good. Um any kind of uh dust or mold or animals, uh anything in the household?

P: No, we don't have any pets and um the place is just renovated so nothing like that.

D: OK. Alright, so yeah, those were just some of the questions that I had for her today. Do you have any questions or concerns?

P: Um yeah, so what can we do for her right now to make these symptoms go away?

D: Yeah, so what we should do for her right now is, she's seven years old, um what I'm thinking right now with her symptoms especially coming on after uh exertion, being worse in the winter, she may have asthma.

P: OK.

D: And although she doesn't have any family history of it, it can happen without family history as well. Um so we would like to uh try and do uh what's called a pulmonary function test. That will help us kind of understand uh if she has um asthma or not and then we can try her on um, it's called a short acting beta agonist, so it's a puffer.

P: OK.

D: And uh usually when she gets these types of symptoms, she can use the puffer to help her. Uh and if it um helps her then it's most likely that she does have asthma and she will need um that puffer and then she might also need another puffer, which is an inhaled corticosteroid, um for the future to decrease um the likelihood that this asthma gets worse in the future.

P: OK, OK yeah thank you.

D: Yeah, no worries. So yeah, so yeah we'll get those tests done and then go from there.

P: OK, sounds great.

D: Take care.

P: You too.