D: What brings you in?

P: Well, I've had this cough but the biggest issue is that I've been really short of breath.

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

P: I would say about 3 days ago.

D: Three days ago, OK, and uh, around that time did you also start feeling short of breath?

P: Uh, the shortness of breath has come on, I don't know within the last day or so. It's come on after that, the cough started first.

D: OK, and the cough, is it a dry cough or is it a wet cough?

P: Well, I've been bringing up some yellowish green, kind of like phlegm, so um I guess a wet cough.

D: OK, so yeah, yellowish green you said.

P: Yeah.

D: OK, any blood in the sputum?

P: I haven't noticed any blood.

D: OK, and how much sputum are you coughing up each time? Like is it kind of the size of your fingertip or does it fill your whole palm?

P: Um, yeah, probably more like the size of like a thumb tip.

D: OK, OK um, and do you notice any, like pus or froth in the sputum?

P: Nothing like that I noticed.

D: OK, and if you were to describe the sound of your cough, does it sound like it's barky or like a hacking cough?

P: I don't know, I guess hacking.

D: Alright, and do you hear any wheezing at all?

P: No, well, maybe I guess when I'm really short of breath, yeah, wheezing, yeah.

D: OK, and the shortness of breath, how severe is it? 1 to 10, 10 being the worst?

P: Maybe a 7?

D: At seven OK, are you having issues sleeping because of your shortness of breath?

P: Uh, well I can't tell if it's that or the cough. I mean between those two things it's been definitely interrupting my sleep.

D: OK, and do you find there are any triggers to your coughing like like um, a particular time of the day? Triggers like you know pollen or things in your environment like pets?

P: No the cough has been kind of going on all day. Um, right when I get up in the morning and goes on all night, it's been getting worse to these last few days.

D: OK yeah, um yeah, that doesn't sound great in terms of your shortness of breath. Do you find that certain positions make it worse? Or like exerting yourself makes it worse?

P: Um, not really.

D: OK, and have you ever experienced anything like this in the past?

P: No, I haven't.

D: OK. And any other symptoms that you have along with your coughing and sputum?

P: As soon as I breath, well, I just haven't felt good like, tired, kind of weakish.

D: OK yeah um, along with your fatigue and feeling weak, have you experienced any dizziness or fainting spells?

P: No dizziness and I haven't fainted or anything like that.

D: OK, any confusion or memory loss?

P: No concerns with my memory.

D: OK. And how about um, muscle aches or any sort of body aches?

P: Alright, yeah, maybe a bit, kind of, and weak.

D: Yeah, alright, so let's go back to your shortness of breath. Do you have any chest pain associated with that?

P: Uh, no.

D: OK, and do you ever feel like your heart's racing?

P: No, nothing like that.

D: OK, and how about changes to your bowel movements?

P: No, those have been normal. I haven't had any diarrhea or constipation.

D: OK and no blood in your stool?

P: I haven't noticed any blood, no.

D: OK, how about abdominal pains?

P: Oh yeah, I don't know why, yeah, my belly's been a bit achy maybe.

D: OK, and how about a sore throat?

P: No, my throat felt OK.

D: OK, good and have you experienced any loss of taste?

P: No loss of taste, but I've noticed, yeah, my smell has been kind of funny.

D: Your smell has been kind of funny, like you can't smell or do things smell differently than you expect them to?

P: Yeah, there was a candle on earlier today and I guess I couldn't really smell it, so I guess I haven't been able to smell.

D: Ok, do you have a runny nose or a blocked nose?

P: No, I haven't had to blow my nose or anything.

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

P: No, that's been normal.

D: OK, any discharge or pain in your eyes or ears?

P: No, that's been OK.

D: OK, and then any changes to your urine?

P: No, I haven't had any pain or anything like that.

D: OK, and are you otherwise healthy? Do you have any medical conditions?

P: Yeah, I have atrial fibrillation. And I do take Metoprolol for that.

D: OK, how long have you had A. fib?

P: It was like 4 years ago I think it was. It was having that like, felt like my heart was racing you were asking about earlier and they did an ECG and I was told I had atrial fibrillation. So yeah, I've been on a beta blocker for three years now.

D: OK, four years, and when was the last time you had an ECG?

P: Uh, maybe just a couple of months ago. I think every time that I come in to see my family doctor, they they do one.

D: OK, and the last time that it was done, was it normal?

P:Yeah, they said yeah. My heart rate's been around 80 beats per minute which is good and I haven't had any symptoms so things have been stable.

D: OK, good. And then have you had any hospitalizations or surgeries in the past?

P: I had an inguinal hernia repair about 15 years ago.

D: OK, any complications from that?

P: Um no.

D: OK, and then besides the Metoprolol, are you on any other medications?

P: Oh yeah, I take a statin and baby aspirin.

D: OK, and is that for the A. fib as well, the aspirin? Or is that just for other cardiovascular issues or some sort of preventative measure?

P: Yeah, I heard it was good for people who have atrial fibrillation so I started taking it.

D: OK. and let's revisit your medications at the end of today's session. I just want to make sure that you're on the medications and I just want to make sure you're on the right dose.  Does that sound good?

P: Yeah, certainly.

D:OK great. And ok, so we talked about your past medical history and medications. We will talk a little bit about any allergies that you have, if you have any.

P: I think it's like a sulfa allergy. I received an antibiotic like that many years ago and had a rash.

D: OK, OK and have you had any reason to suspect that you may have taken any sulfas recently?

P: No, I haven't had any antibiotics so no, really no changes.

D: OK, OK, good and are you up to date with all your immunizations?

P: I am yeah. I've received the Zoster vaccine for shingles and also the one for pneumonia.

D: OK, good, good yeah, those two we definitely recommend if you're over 65. OK, and do you know of any family history of lung conditions or heart conditions?

P: No, I think my aunt had lung cancer but she smoked her entire life.

D: OK, OK and how about other cancers?

P: No other cancers.

D: And have you been in touch or do you think you've been in contact with any anyone sick recently?

P: Well, I visited my mother at a long term care facility just this past weekend, so I guess about just over a week ago I visited there.

D: OK, and have there been any COVID outbreaks at the long term care?

P: Yeah, there has been, I thought I was like away from those areas but I have heard about outbreaks there.

D: OK, OK and any travel history?

P: No travel.

D: And do you smoke?

P: I used to smoke a pack of cigarettes a day, but I quit about, uh, about five years ago. I know four years ago it was when I found out I had atrial fibrillation. I quit.

D: OK, OK, well that's good. Good for you for quitting. How about marijuana?

P: No, I don't smoke it, but I'll use some edibles I buy from the Ontario stores a couple of times per week. Just the CBD stuff.

D: The CBD stuff OK. And how many milligrams?

P: I'm not sure, I know it's their lowest dose though.

D: OK, OK if it's lowest dose, it might be 2.5 milligrams.

P: Sounds familiar.

D: OK good. Is there a particular reason you take these CBD edibles?

P: It helps me sleep.

D: OK, if it's specifically to help you sleep, we can actually try and see if there are other options for you. You know there are pills, like they are sleep aids. Or even things like melatonin that can help regulate your sleep so we can revisit other options for you if you're open to that as well.

P: OK for sure. Yeah I will. Um, yeah we can talk about that later.

D: OK, that sounds good and do you do any other recreational drugs?

P: I do not.

D: OK, how about alcohol?

P: Uh, no, I don't drink anymore.

D: OK, and did you used to drink before?

P: Yes, I just stopped a few years ago,

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

P: I live in a house with my wife.

D: In a house, OK. Any concerns for like old carpets, mold or asbestos in your house?

P: No, we've renovated it over the years.

D: OK, good and I apologize, but I would like to clarify three more symptoms with you. Did you say you felt like you had a fever earlier?

P: Um, maybe I've been feeling a little hot, but it's been really more the cough and shortness of breath that's been bugging me.

D: OK, well we can take a temperature today just to make sure. Have you been feeling like you have night sweats or chills?

P: Um, not really. No, I haven't noticed that.

D: OK, and how about, um, any weight loss over the past few months?

P: No, it's been been stable.

D: OK, alright good, so that brings us to the end. Do you have any questions or concerns that you would like to clarify before we end the interview?

P: No, nothing today.  I was just really hoping to get, uh, whatever this is sorted out.

D: Yeah, you know, um, right now it looks like, it sounds like it could be an upper respiratory viral illness, so that includes COVID.  So we will do a swab for you and then send it off to the lab for PCR results. In the meantime, because you have symptoms that overlap with COVID symptoms, we do encourage isolation for 14 days. Until your symptoms are gone, sorry,  until your symptoms are gone, even if they're gone, we do suggest isolating for 14 days just to make sure you're not a carrier or could spread COVID so we do encourage that, and that includes from your husband. If possible, we will get those results in a day or two. If they are positive, we will send your results to public health who will be in touch with you to do some contact tracing to see where you may have gotten it from. If it's not COVID, it could be other viral illnesses that are going around this time of year. And if your symptoms aren't getting better on their own, and there's reason to suspect you may have a bacterial infection or bacterial pneumonia, we will follow up with you and possibly prescribe antibiotics. How does that sound?

P: Yeah, that sounds like a great plan.

D: OK, great so um, I will see you at the next appointment.

P: Thank you.


D: How may I help you?

P: Hi, I'm I'm coming in because um I've had a lot of shortness of breath and I I've had this cough that won't seem to go away.

D: I see alright, so when does the shortness of breath happen it? Do you have it at rest or is it on exertion?

P: Mostly on exertion.

D: OK, how far are you able to walk before you get shorter breath? Or how many flights of stairs are you able to do?

P: Uh maybe like 2 flights of stairs?

D: OK. And when did you notice that the change?

P: So I've had this shortness of breath like at first it was pretty mild. It started about, four months ago, but over the past month or so, it's been it's been worse.

D: OK, so a bit so it's been going on for a bit of time now.

P: Yeah,

D: OK um. Do you, are you able to lie down flat without experiencing shorter breath?

P: Yeah, I think so. I think that's fine.

D: OK, um so so it sounds like no orthop is what they call it, and have you had any episodes where you wake up in the middle of the night and you're short of breath and you need to sit up an end to catch it?

P: Uh no.

D: OK, and have you had any leg swelling?

P: No.

D: OK. Any, you mentioned that you've had a cough as well. How long have you experienced a cough for?

P: Uh, the cough also around the same time it started off pretty mild, but now I like I have it all the time.

D: OK, are you coughing up any sputum or any phlegm?

P: Uh no it's it's pretty dry.

D: Are you coughing up any blood?

P: No.

D: OK. And have you had any um wheezing?

P: No wheezing.

D: OK. How how about any chest pain?

P: Uh no chest pain, I guess with the coughing 'cause I'm coughing so much it hurts but not chest pain in the sense like it's in the area of my heart or anything like that.

D: OK, so does that. Like how would you describe it? Is it like sharp, achy, uh dull or pressure like?

P: Um it's a. It's kind of like a tugging feeling.

D: OK, um it does it go away after you're done coughing,

P: Yeah.

D: I see OK. And have you experienced any um any headaches?

P: No, no headaches.

D: OK, how about any um? Like eye redness or eye discharge?

P: No.

D: any ear pain or your discharge?

P: No.

D: How about any changes to vision or hearing?

P: No.

D: OK. Have you had a runny nose or sore throat?

P: No.

D: OK, how about um any changes to or have you had any loss of smell or any loss of taste?

P: No.

D: OK. And have you had a loss of appetite?

P: No.

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

P: Um I have had some weight loss actually. About 15 pounds over the past six months.

D: OK, and have you been trying to lose weight?

P: No.

D: OK. Um have you had any fevers?

P: No.

D: Have you had any chills?

P: No.

D: Have you had any night sweats?

P: No.

D: OK. Um and have you had any heart palpitations or feeling like your heart's racing?

P: No.

D: Have you had any fainting or lightheadedness or dizziness?

P: Um no.

D: OK. Um have you had any abdominal pain?

P: No.

D: Have you had any nausea or vomiting?

P: Uh no.

D: have you had any diarrhea or constipation.

P: No.

D: And, have you had any skin rashes?

P: No.

D: Have you had any muscle aches or joint pains?

P: No.

D: And have you had any ah confusion or memory loss?

P: Uh No.

D: OK, OK, and how is your energy been uh recently have you had any fatigue or malaise?

P:  Um no.

D: OK, alright so it sounds like this this dry cough and then and shortness of breath it is mostly what you been um experiencing and have you been diagnosed with any medical conditions?

P: Ah I have uhm a COPD.

D: OK, um and do you use uh any medications or any inhalers?

P: Um know it's very mild. I it’s yeah, so I haven't really. I was just recently diagnosed so uhm I haven't been started on any medications just yet.

D: OK, did you, do I I pulmonary function tests where you're breathing into a tube,

P: yeah

D:  Alright. Yeah, and uhm do you have any allergies?

P: No.

D: Um and have you had any hospitalizations or any previous surgeries?

P: No.

D: OK and could you tell me a little bit about your living situation? Like where you're living and who you're living with?

P: I live in a house with my husband.

D: OK, and has your husband been sick or anybody you've been around been sick?

P: No.

D: OK. And are you currently working?

P: Yeah, so I. I'm working in construction. Um I used to work in shipyards before, but recently I've I've been doing some construction, nothing heavy, ah just working on some old buildings. I’ll ust take the odd job or something that comes up. It's not full time.

D: OK. And any concerns for like exposures while you're at work in terms like breathing in any dusts or any fumes.

P: Um were given a um personal protective equipment um for those concerns, but when I was younger I used to work a in shipyards and constructions and like old buildings and stuff, and I know there was some concern for not being ah properly equipped with the right equipment for protection and safety at that point so. Uh yeah, it's possible. I've been exposed to some things.

D: I see is there a chance that there could have been asbestos at any of those places that you worked?

P: Yeah, asbestos or mold. Yeah, you name it. Probably everything.

D: Yeah, I see this was like 10 years ago 20 years ago or or longer?

P: Yeah, and so it would have been. Yeah, about like 30 years ago or yeah 30, 40 years ago and. I worked in those places for 30 to 40 years, so. Around that time.

D: OK, and do you smoke cigarettes?

P: Um I quit recently since I found out that I might have COPD.

D: Oh congratulations, it's not easy to quit.

P: Thank you.

D: Uh and do you drink alcohol?

P: Uh once in a while? I’ll have a glass of wine once a week.

D: OK, and do you use recreational drugs?

P: Um no I don't.

D: OK. Um and uh are there any heart or lung conditions that run in the family?

P: Uh no.

D: OK, are there any cancers that are in the family? Like anybody who's had lung cancer?

P: Um. No, not that I can think of.

D: OK. And um have you traveled anywhere recently?

P: No.

D: OK, and are you currently sexually  active?

P: I am.

D: OK um and can you tell me about your partner or partners? Is it's at your husband or um anyone else?

P: Just my husband yeah.

D: OK and any concerns for ah sexually transmitted infection?

P: No.

D: OK. And I think that was everything that I wanted to ask on history today. Um was there anything else that you wanted to add that I maybe forgot about?

P: Um no that was it, but how like what can I take to make these symptoms go away?

D: Well yeah, so at this time It will be important to get some lung imaging and and possibly, some other investigations as well because of your exposure uh to inhalants and fumes, and possibly asbestos. So I’m concerned there could be possibly an asbestos related lung illness that that you have. Um and so it will be important to investigate for, yeah possibly a asbestos related lung cancer,

P: OK?

D: Yeah.

P: OK, thank you.


D: So what uh, brings you here today?

P: I am here with uh, with my daughter, who has just been having a cough for the past um, two weeks.

D: Okay, um, and can you describe the cough a little bit? Is it a dry cough or is she bringing anything up?

P: Um, it is a, it is a dry cough, um, but she just keeps coughing and coughing and, and then she just, you know, once she'll start coughing she just doesn't stop. And then um, there's been times when she just turns blue, she's coughing so much. Um, and then it just gets, gets better um, on its own. But yeah, it's a dry cough.

D: Okay, and um, what does the cough sound like? Is it like a harsh cough, a barky cough?

P: Um, it's just, she just makes this noise when she's like breathe, trying to take a breath in. It's, it's yeah.

D: Okay, is it kind of a wheeze?

P: Yeah, sure.

D: Okay. Um, and so there's episodes where she also turns blue?

P: When she's coughing a lot, yeah, she does.

D: Okay.

P: She's also vomited once or twice.

D: Oh, I see, okay. Um, any blood in the vomit? Or is she coughing up any blood?

P: No.

D: No, okay. Um, any, so this started two weeks ago, any kind of symptoms of runny nose or um, cold-like symptoms before then?

P: Yeah, yeah she did have a bit of a runny nose. It was just uh, watery, uh, since discharge. And at that time her cough, she had a cough as well. Um, but I thought it was, you know, it's nothing. It was just like another flu and it would get better, but then she just, the runny nose got better without, in a couple of days, but the cough stayed. And it got, got pretty worse, uh, it got worse.

D: Okay, um, other than the cough uh, any, any fevers or chills?

P: No, I don't think she's had fevers. I haven't checked, though.

D: Okay. And the cough is pretty constant, or is it, does it come and go?

P: Yeah, she just has these episodes where she just coughs and coughs and coughs, and then she'll either vomit or just turn blue, or just um, get better in a couple, couple minutes. This kind of comes and goes like that.

D: Okay. And is there anything that has helped her at all? Like any over the counter medications or anything like that?

P: I haven't tried anything, I'm just worried about, you know she's my first child and I don't know what to give her and what not to give her at this age. So I just decided to come in and not try anything over the counter.

D: Okay. Um, and so, has this happened before at all?

P: No.

D:  No, this is the first time, okay. Um, any so, she, she is vomiting. Um, is the vomit like green in colour? Or is she just vomiting up what she has eaten? What's the content of the moment?

P: It's usually just what she's eaten.

D: Okay, um, any sick contacts recently or any travel?

P: No, I don't think so. Not, nothing really.

D: Um, and how about her behaviour? Does she seem like uh, very tired or fatigued, or more irritable?

P: She does get tired, especially after, and then she's irritable and crying after, you know, she has these fits of coughs.

D: Okay.

P: Yeah.

D: Okay. Um, any symptoms of diarrhea or constipation?

P: No.

D: Okay. Any um, any trouble with urinating at all?

P: No.

D: No. How's her sleeping like?

P: Uh, not great. It's just the cough keeps uh, waking her up and she just doesn't, can't fall asleep.

D: Okay, any uh, exposure to dust or fumes, or animals or pets at home?

P: We, we did get a cat um, about a month ago.

D: Okay. Um, and any, has she been diagnosed with any medical conditions in the past?

P: No.

D: Um, and any allergies that you know of?

P: Um, no.

D: And um, any previous hospitalizations or surgeries?

P: No.

D: And how was your pregnancy, your pregnancy with her, like any complications at all?

P: No, no complications. It was uh, it was very, yeah, it went well.

D: And was she at term or premature?

P: She was at term, she was born at term.

D: Was it a vaginal delivery or uh, a c-section?

P: Uh, vaginal.

D: And did she have to stay in the NICU at all, at the hospital afterwards?

P: No.

D: Okay. And is she feeding well, like what does she usually eat?

P: She's feeding well. She's doing uh, she eats everything, yeah.

D: Um, and any family history of any medical conditions?

P: No.

D: Um, and does anyone smoke in the house?

P: Um, her dad, but he, he doesn't smoke in front of her.

D: And what's her living situation like? Who does she live with? And do you live in a house, apartment?

P: Oh yeah, we live in an apartment. It's uh, me, my partner, her and the cat.

D: Okay. And any difficulties or complications with her growth? Like in terms of her weight or her height?

P: No, no complications. She's doing okay.

D: Okay. And in terms of her milestones, has she been meeting all of them on time?

P: Yes.

D: Okay. Alright, so I think those are all the questions I have for you today. Do you have any questions or concerns?

P: Uh, no.

D: Yeah, so based on the symptoms, oh yeah, sorry I forgot to ask one other question. Has she, are her immunizations all up to date?

P: Oh no, no. I don't, I don't get those. My friend's, my friend's daughter developed autism and I'm just, I don't want that, you know, so no. I don't vaccinate my kids. Or I don't vaccinate my daughter and I haven't been. Yeah, uh no, I won't be doing that.

D: And have you been vaccinated throughout your life?

P: Um, maybe when I was young, but I, yeah I don't, I just don't believe in vaccinations. I, yeah, no, I don't, I don't get those.

D: Yeah, so there is definitely uh, there's a lot of research done beside, behind vaccinations and a lot of prevention goes into them, but definitely there is some anecdotal evidence of very loose associations to autism that have been found to be invalid and like they have been invalidated by the research. So definitely, it's very important to get your child vaccinated. In fact, the sum of the symptoms that your child may be having right now can be caused by something called pertussis, and um, there's usually a vaccination for that. Like after pregnancy as well, so that's something that is definitely on the differential, and at this time we definitely need to make sure she's okay and get her vitals done, see her oxygenation saturation, and just do supportive care while she's in the hospital, and we may need to admit her, but we'll do the full physical examination today, get a COVID swab done as well. And usually it, she's currently in the, it seems to be the second phase, where she's vomiting and coughing a lot, and then it usually, after that phase, two or three more weeks of just coughing. And so, we're going to do some supportive care for her right now, but yeah, definitely, you should consider vaccinating your child. We recommend that to every parent as there's a lot of diseases out there that can be completely prevented if you vaccinate your child.

P: Okay, I'll think about it.

D: Alright, so, so for now we're gonna just make sure that she's doing well, okay?

P: Sure.

D: Alright, take care.


D: How can I help you today?

P: Hi, I'm, I'm the mom of the patient and I just wanted to talk to you about the, just about Thomas here. He's just been not, he's just not been feeling well. He's had this cough for the past three or four days. And he's also had this stuffy nose, and this, this watery discharge. Yeah, he's just not feeling good.

D: OK, I see and so the, the cough you said started three or four days ago. Has the cough gotten any better or any, stayed the same or gotten worse?

P: Gotten a bit worse, I would say.

D: Is he bringing up any sputum?

P: No.

D: So has there been any blood?

P: No no.

D: OK, and has the cough interfered with sleep?

P: Yeah, his cough is usually worse, uhm, at night.

D: OK. And you say that he's also had a runny nose. What does the discharge look like?

P: It's just, uh, it's watery.

D: And this started three or four days ago as well?

P: A little, a little after the, uhm, yeah actually, around the same time, around the same time, yeah.

D: OK. Has he had any, uhm, like difficulties breathing, like saying that he feels one of the, like the nostrils obstructed?

P: Hmmm, he hasn't, well, he's just been breathing with his mouth open, so that's what he does at night as well. He also has this nasal voice right now, probably because it's, it's, you know, he has this stuffy nose. But he hasn't really complained about it.

D: Yeah, has he had any pain, like facial pain?

P: Uhm, no, not really.

D: OK, how about any changes to smell or loss of smell?

P: Yeah, I don't think he can smell much right now.

D: OK, and uh, did those, did that start a few days ago as well?

P: Yeah, yeah, since he's been complaining of his stuffy nose.

D: OK, and has he had any headaches?

P: No, but he has had a fever.

D: OK. How, did you check it?

P: Yeah, I did, I did. It was uh, 39 last night.

D: Alright, it's certainly a fever. Uhm,  has he had any chills or night sweats?

P: Yeah, he's, but he's been feeling pretty chilly.

D: OK.

P: Yeah, he's wearing a couple, a couple of layers at home, still feels chilly, and yeah, he has alot of chills and definitely has a fever.

D: Alright, and has the fever been there the whole whole time, if you're aware or has that kind of come and gone?

P: Uhm, you know what, I actually just checked yesterday so I don't know.

D: Alright, has he had a sore throat?

P: Yeah, it's usually worse in the morning. I think it's more of a, I guess the post nasal drip you know with the, with a runny nose. It's just, It's pretty bad in the morning.

D: OK, has he had any red eyes or, or eye discharge or eye pain?

P: No no no.

D: OK, and has he had any shortness of breath?

P: No.

D: How about any wheezing?

P: No.

D: Any chest pain?

P: No.

D: Any lightheadedness, dizziness or fainting?

P: No.

D: OK, and does he mention anything about feeling as though his heart's racing?

P: No.

D: OK and has he had any abdominal pain?

P: No.

D: Any nausea or vomiting?

P: No.

D: Any diarrhea or Constipation?

P: No.

D: How about any urinary problems like pain or, or frequency?

P: No, nothing like that. He hasn't complained of anything like that.

D: Has he had any skin changes or rashes?

P: No.

D: And how about any muscle aches or joint pains?

P: Yeah, yeah he definitely has that. He's complaining a lot about muscle aches.

D: OK, and how has his energy been? Has he been fatigued?

P: Oh yeah. He hasn't gone out to play. He hasn't done anything, he's just been lying in bed.

D: OK, and over the last several months has he had any weight loss?

P: No. He's been gaining weight actually.

D: OK, no that's good. Certainly yeah, at the age of 11 should be still gaining weight, so that's good. And has he been diagnosed with any medical conditions in the past?

P: Yeah, he was diagnosed with uh, cystic fibrosis when he was a, he was a child, four years old.

D: OK, and, uh, is he on, uh, like any medications for that?

P: He's on, he was on an antibiotic until the age of five. Uh, that he had to take on regular basis, but he is, he's not really on any medications right now. I know that there are a couple of new ones that are out there, but those are very expensive.

D: OK, and has he had any exacerbations or hospitalizations?

P: uh, yeah, he's he's had about, uh, one hospitalization every two years?

D: Alright, and is he followed by a respirologist, currently?

P: Yes, yes, yes.

D: OK, uhm and has there been, like an increase in the sputum production or like worsening shortness of breath over these last few days?

P: No, not really.

D: OK. And has he had any surgeries?

P: No.

D: Does he have any allergies to medications?

P: Uhm, Sulfa drugs.

D: And the reaction is?

P: Uhm, he just gets a rash.

D: OK is it, are immunizations up to date?

P: Oh yeah, yeah, we're very careful about that given his diagnosis. He's got all the, all the vaccines.

D: That's great, that's really important for sure, uhm, and so I just wanted to ask about life at home a little bit. So who's in the house and who's the primary caregiver for him?

P: I'm the primary caregiver, its just, uh, me, him and my husband.

D: OK, and uh, is he, uh, what grade is he in right now?

P: He's in grade six?

D: OK, how is school going?

P: Schools going well, it's just the, yeah, the hospitalizations can sometimes be disruptive, but it's going well. He's, he's getting B's in his class. He's doing well, he's got a good group of friends.

D: Excellent and have you had any concerns about about development or, or his growth?

P: Uhm, no.

D: OK, so meeting all milestones and?

P: Yeah.

D: OK. And in regards to, uhm, birth history, were there any complications throughout pregnancy or, or at birth?

P: Uhm, no, nothing at birth or during pregnancy, but he did start having lots of respiratory infections, which is when the pediatrician did that test. I forget the name, for the test and then they were, uhm, the, uhm, he was found to have, CF.

D: OK, uhm, and does anybody in the home smoke?

P: No.

D: Or drink alcohol?

P: no.

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

P: No.

D: OK, has he been around anybody who's been sick?

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

D: OK, and, uh, have you guys traveled anywhere?

P: No, just been at home.

D: OK, uhm, and has anybody in the, else in the family have cystic fibrosis?

P: No, no, no, no one else does. But we got tested and we were both found, my, my husband and I were found out have the gene for it. We were carriers.

D: OK, uhm, I see. And any, any heart conditions or, or other lung conditions that run in the family?

P: No, nothing else.

D: OK. And were there any other symptoms that, or anything else that you wanted to tell me that maybe I forgot to ask about?

P: Uhm, no, I was just, uh, I'm just worried about him, uhm about his fever specifically, it's been high and I know that usually when he has these hospitalizations, he presents pretty similarly. So just wondering if he would need to be hospitalized again and if he needs antibiotics.

D: Yeah, for sure it's, it's been uhm, so it's been three or four days, but with a fever this high and his symptoms, with uh, having obstruction, discharge, uhm, changes to smell or loss of smell it does sound like it could be bacterial and so I think it would be reasonable to possibly to start antibiotics in this case, but we'll go through, through a physical exam, check some vitals and go from there.

P: Ok, Ok, sounds good, thank you.


D: It's nice to meet you. What's your name?

P: It's nice to meet you as well. My name is Jenn and I'm here with my son Joey here, who he's had a sore throat now for the last couple of days.

D: OK, how old is he, Joey?

P: Uh, he is 3 years old.

D: He's three years old, OK. And you said for the past couple days, so about 2-3 days?

P: Yeah, probably yeah about 3 days ago he he didn't go to school for the last two days because, or I mean daycare I should say because the pains but was bugging him so bad.

D: OK, yeah um. So how long has he been going to daycare for?

P: He started this year, so, um, he's been going for about six months.

D: OK? Is he having issues swallowing food? Does it hurt when he swallows food?

P: Yeah, he's, uh, he's definitely the last couple of days hasn't been eating as much like solid food. He's drinking cold liquids okay but yeah, he hasn't been eating as much.

D: OK.

P: He says it's hard to. He does say it hurts to swallow as well.

D: OK, and does does he ever clutch to his neck like his neck hurts?

P: No, he hasn't said anything like that. I mean nothing about his neck.

D: OK, um, have you taken his temperature at all?

P: Yeah we did and it's uh, it's pretty high actually, it was like 39.4.

D: OK wow, yeah that's pretty high. Have you noticed any swollen areas on his neck?

P: No, not I haven't noticed anything on his neck.

D: OK, any rashes that you've noticed?

P: No rashes.

D: No, OK. And has he been having chills or night sweats?

P: Um, nothing like that that we've noticed, no shaking or or sweaty bed.

D: OK, and how about like a stuffy nose or runny nose?

P: Uh, no, nothing like that.

D: OK, and coughing?

P: No cough.

D: No, and how about is he complaining of any body aches?

P: No, it's mostly just been is his throat his throat that he's complaining about.

D: OK, how about headaches?

P: Uh, He hasn't mentioned anything with his head.

D: OK, and has he been around anyone who's been sick?  Maybe at his daycare?

P: I, I mean, his sister has had had some colds. She's also in his daycare. So I mean, maybe her.

D: OK, how old is she?

P: Um she's 2.

D: She's two. OK, so she's younger.

P: Yeah.

D: OK, any nausea or vomiting?

P: Ah no vomiting.

D: OK, how about um, diarrhea, constipation?

P: Haven't noticed anything like that, his his bowel movements have been normal.

D: How about urinating, has that been normal?

P: His usual amount is as, as far as I know.

D: OK. And OK, any issues with his eyes? Any like pus or bleeding or redness?

P: No, his eyes of have looked normal to me.

D: OK, how about his ears?

P: Those have also been normal.

D: OK, any sores on his mouth or inside?

P: Um no, it does kinda look like there. It's pretty red in the back of his throat when I was able to look, but yeah.

D: OK, and has he ever experienced any of these symptoms before?

P: Um, he's had sore throats before, but I think this one is a bit more severe. He hasn't complained this bad before.

D: OK, OK. Um has he tried anything for it? Have you given him any over the counter medications?

P: Yeah, we we did use some Tylenol and it brought the fever down so that was part of the reason why we we didn't come in 'cause he's had sore throats before but the fever bounced back and and the pain seems to have continued so we came in.

D: Ok, OK. And is he otherwise healthy? Does he have any medical conditions?

P: Uh, yeah, he's otherwise healthy no medical conditions, um hasn't been, had a reason to see a doctor before.

D: No, OK. And then just how was pregnancy with him? Was it normal? Any complications?

P: Um yeah there, so had um gestational diabetes, but it was treated, it was treated with diet. Um and blood sugars have been fine now, but no complications to the pregnancy from that regard as far as I know.

D: OK, any alcohol or recreational drugs used during the pregnancy?

P: No, nothing like that. No. No smoking either.

D: OK, OK, good um and how far along were you when when you delivered him?

P: Um it was a vaginal delivery just after 38 weeks. OK so he was full term.

D: And you said vaginal delivery? Did they have to induce you at all?

P: Um no no.

D: OK and was he a normal birth weight?

P: Yeah he was. Yeah, I think he was like just over 3 kilograms.

D: OK, good and was he healthy after birth? Did he have any breathing issues? Jaundice? Anything like that?

P: Um, no breathing issues or or jaundice. He came home with us right away.

D: OK, OK and then after that point to now has he been normal in terms of his weight, height, head circumference?

P: Yeah yeah. He's been growing normally and eating well up up to this point.

D: OK, and I should ask um has he been hitting all his milestones like, is he doing the things that his peers are doing?

P: Yeah, I would say he's keeping up with his his peers in daycare and no concerns with his development.

D: OK, good. Is he on any medications?

P: No medications.

D: No. OK, and is he up to date with all his immunizations?

P: He is yes.

D: OK, and any allergies?

P: Not that we're aware of.

D: OK, any family history of lung conditions?

P: Um no, no family history of any lung conditions.

D: OK. And So who does, who does he live with at home?

P: So he lives with my myself, and his father and then sister. So there's just the four of us at home.

D: OK, and what's the relationship like between all of you? Any domestic issues? Or are things OK?

P: Oh, things are are great at home. It's a really supportive environment.

D: OK, good and does anyone smoke at home?

P: No one smokes at home.

D: No, OK. Um, any carpets at home? Old carpets?

P: I think there's there's a few area rugs around, but most of the carpets are gone.

D: OK, OK Um alright, so it sounds like, um grom what you're telling me, he ohh sorry, I should have asked you this earlier. Has he had any issues breathing?

P: Um no problems breathing, but his voice does sound a bit, a little bit off. A bit Husky.

D: A bit Husky, OK. Um alright and nothing like a seizure like a febrile seizure, right?

P: No, I haven't seen any like limb jerking or anything like that.

D: OK, so um, just roughly doing from the sounds of it, it sounds like he has a sore throat that's been persistent and we do this thing called the Centor score. So it sounds like he's had a fever, no cough, a sore throat. So the first thing that we want to check to see or to rule out would be a strep throat and then well if that comes back negative we will go from there and think about other viral causes versus strep throat as well.

D: Did you have any questions or anything that I missed that you wanted to discuss today?

P: Um, no. We were thinking that it could be, uh, maybe strep throat. So um, yeah, thank you.

D: OK, great, thank you.


D: So what brings you here today at the family clinic?

P: I haven't been coughing these last two weeks since I got back from Mexico. I think I got sick there.

D: OK, so just the last couple weeks you've been coughing?

P: Yeah, ever since I got back from Mexico it's been yeah so about about two weeks.

D: OK. And is your cough for a wet cough or dry cough?

P: It's dry and I'm not bringing up any any sputum.

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

P: No blood.

D: No, OK. And is the cough constant or does it come and go?

P: It, it comes and goes. I would say sometimes it can be worse. Yeah, depending on on what I'm what I'm doing. I guess if I'm exercising or if it's if it's really cold outside, it might get worse.

D: OK. And do you feel that it's been getting worse at all, your cough?

P: Uh, not really, I think it's about the same.

D: OK, and anything that you did when you were in Mexico that might you think might have caused your cough?

P: Uh, I don't know, maybe I, I was drinking a little bit too much and partying a little bit too much so might have got sick while I was there.

D: I see. Did you have any cold symptoms like runny nose, sore throat? Um, any anything like that when you were there or after you came back?

P: No, sometimes my eyes can get a little itchy, but no runny nose or sore throat.

D: OK, have you had any previous episodes that are similar to how you're feeling now?

P: Uh, maybe years ago when I like when I was in elementary school, but nothing for the last few years.

D: OK, and how often are you coughing? Let's say in an average day?

P: Um, it's uh, it's pretty variable. I would say, so if I'm exercising it will it'll throw me into a coughing fit and and sometimes it's really bugging me at night too it'll affect me. It's impairing my sleep.

D: OK, and so exercise makes it worse. Anything that you do that helps you relieve the cough?

P: Uhm, I actually I tried my sons inhaler and it seemed to actually help, but one of the days I just couldn't seem to stop the cough and I wanted to sleep so I gave it a try and it it seemed to actually help with the cough.

D: OK, and so your son has inhalers, does he have asthma?

P: Yeah he does. Yeah he was diagnosed with asthma a couple of years ago.

D: OK, and have you previously been diagnosed with asthma?

P: Ah I think if they've said it before when I was young, but I haven't had any symptoms for for for years.

D: OK, and besides the cough, do you have any other symptoms, like any cold symptoms of runny nose, sore throat right now, or even like any chest pain?

P: No, nothing like that.

D: OK. And do you have any symptoms like a headache or nausea or vomiting?

P: Uh, nope. No headache, nausea or vomiting.

D: OK. Is your cough at all worse during the day or at night? Or does it just is at around the same throughout the day?

P: I think the coughs worse at night.

D: OK. And do you ever feel that you're short of breath at all?

P: Well, yeah, so it affects me if I'm outside and that that's actually usually when my eyes will get itchy too.

D: OK. And have you had any eczema in the past?

P: Uh, yeah I had, I had eczema when I was I was younger. I think that was in it when I was in elementary school as well.

D: OK. Have you had any fevers or chills recently?

P: No.

D: Any night sweats?

P: No.

D: Have you been feeling increasingly tired throughout the day?

P: Ah no, my energy's been been good I just get short of breath or or have these coughing fits if I, if I exert myself.

D: OK, have you noticed any swelling in your feet or hands?

P: No.

D: Any dizziness?

P: No dizziness.

D: Do you ever feel your heart is racing when you get like these thumping like heart palpitations?

P: Uh, nothing like that.

D: OK, and you said no chest pain, right?

P: No chest pain.

D: OK. Have you noticed any changes in your bowel movements? Any constipation or diarrhea?

P: No diarrhea.

D: OK. Any changes in your urinary patterns?

P: No, everything's been normal.

D: OK, so you mentioned like the coughs been keeping you up at night. How, how often are you waking up at night? Is it pretty frequent?

P: I would say about two or three nights a week over these last two weeks. It's been, it's been getting worse.

D: OK. And have you noticed any changes in your weight at all?

P: My weight's been about the same.

D: OK, any changes in your appetite?

P: No, been eating well.

D: OK. Any recent exposures to anyone with tuberculosis that you know of?

P: No.

D: No, OK. Have you lost your sense of taste or smell recently?

P: Neither of those.

D: OK. And have you been exposed to any fumes or dust in your surrounding area, or do you have any pets or animals at home?

P: Um, yeah, we have a, uh, two cats. And, but nothing at work.

D: OK. And how long you've had those cats for?

P: We've had them for for almost a year.

D: OK. And other than eczema and remote history of perhaps asthma when you were younger, any other medical conditions like diabetes or high blood pressure that you've been diagnosed with?

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

D: OK. Any medications that you are on currently?

P: Uh, no medications.

D: OK, do you know of any allergies to any environmental exposures or any medications at all?

P: Uhm yeah, I think I have, I'm allergic to pollen and some other environmental and allergies as well.

D: OK, and when you cough, have you ever noticed like wheezing noises at all?

P: Uh occasionally yeah, there, though I do notice a wheeze.

D: OK. And have you ever been hospitalized before?

P: No, I haven't.

D: Ok, any previous surgeries?

P: No surgeries.

D: OK. And has anyone around you been ill recently?

P: Everybody's been healthy.

D: OK. And do you have any family history of cancers or anything related to the lungs at all?

P: Uh, no. I mean, my sister had eczema as well, but that's it.

D: OK, that's it. OK, uh, any heart attacks in your family? Any other medical conditions?

P: Uh, no. Everyone's healthy.

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

P: Yeah, so I live in an apartment nearby with my boyfriend.

D: OK, and has there been any, have you moved there recently or how long have you lived there for?

P: Uh we've lived there for about four years now.

D: Four years, OK. And has anything changed recently? Has there been any mold or new carpets that you guys got anything new in the house?

P: Uhm, I don't, I don't think so.

D: OK. And do you currently work?

P: Yeah, I work as a a school teacher.

D: OK. And do you smoke at all?

P: No, I don't.

D: Have you ever smoked?

P: I did, yeah I, I smoked a pack a day up until just about a month ago. I made, it was a New Year's resolution to quit.

D: Oh wow, well congratulations, that's it's definitely very difficult to quit. And if you need at all, any help at all with your transition at all, we can always bring it up in any appointment.

P: OK, thank you.

D: Yeah. And in terms of recreational drugs, do you use marijuana or cocaine or any other recreational drugs?

P: Um, yeah, maybe I'll I'll smoke like one or two joints a week.

D: OK. And do you drink alcohol?

P: Uh, yeah, maybe a bottle of wine on the weekends.

D: OK. Uhm, so you go through like around a bottle every week?

P: Yeah, I would say about a bottle of wine on throughout the week, but usually don't really have any during the week, I'll usually, I guess, split the bottle between between Friday to Sunday sort of thing.

D: OK. And in terms of exercise, do you find that you're getting adequate exercise throughout the week?

P: I tried to, I tried to run and go for walks but always trying to be a little bit more active.

D: OK. Alright, so yeah those are all the questions I had for you today. Um, do you have any other questions for me?

P: Uhm, nope, that was it.

D: OK, so based on what we talked about, it seems that based on your past history and the coughing that you're having right now, one of the things that we definitely want to look at is if you do in fact have asthma. Um, it can also be like viral upper respiratory tract infection, but we will do some pulmonary function tests for you and see if the bronchodilators just like you use the inhaler from your son if that helps helps you with your symptoms and then we can go from there.

P: That sounds great. Thank you.

D: You're welcome. Well, take care.


D: What brings you in?

P: Hi. Uh, I've just had this cough for the past week and I was worried I might have Covid so I just wanted to um I just wanted to be checked.

D: Sure, so you mentioned you, it started a week ago.

P: Yeah.

D: Has it been persistent or does it come and go?

P: Um it's just been there.

D: Been there. OK.

P: Yeah, I just get this itchy sort of uh like scratchy sensation in my throat. And then I just cough and um that makes it better.

D: OK. OK, uhm what, how would you describe your cough like is it barky? Is it harsh? Is it muffled?

P: Uhm no, I don't I don't think it's barky or harsh.

D: OK, and does anything make it better or worse like you know, like the cold air, laying down, at particular time of day?

P: Not really, I haven't uh, nothing's really helped. Um I also tried a cough syrup, um it didn't, it helped for a couple hours, but then it was back again. The cough was back again.

D: OK, and have you ever experienced anything like this in the past?

P: Uh well, I I said yeah when I get a cold.

D: Mhmm, OK.

P: Once a year maybe.

D: Once a year? OK. Um do you experience any shortness of breath with this cough?

P: No.

D: No, OK. Is it a dry cough or do you bring up any phlegm?

P: No, it's a dry cough.

D: OK, uh any blood that you've seen?

P: No, no.

D: No, OK. And do you feel wheezy?

P: No.

D: No, chest pain?

P: No.

D: No, um feeling like your heart's racing?

P: No.

D: Any swelling in your limbs?

P: Uh no.

D: No, any fainting spells?

P: Uhm, no.

D: No, OK. Do you ever feel like your nose is stuffy or runny?

P: No.

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

P: Uh no.

D: A sore throat?

P: No.

D: Um loss of smell or taste?

P: No.

D: Any weight loss?

P: Uh no.

D: Fevers?

P: I checked no, no, I don't have a fever.

D: No, any rashes?

P: No.

D: Issues uh, any changes in your bowel movements?

P: Um uh no, I've just been constipated from time to time, but that's nothing, that's not new.

D: OK, constipation. And I'm sorry when did your constipation start?

P: Oh it's a problem for years. I don't eat enough fibre.

D: Oh, OK. Any changes in your urine?

P: No.

D: OK, any nausea or vomiting?

P: Uh, no.

D: No, OK. Any joint pain?

P: No.

D: No, numbness or tingling?

P: No.

D: Headaches?

P: No.

D: No, OK. Are you otherwise healthy? Do you have any longstanding medical conditions?

P: I have diabetes.

D: OK, how long have you had diabetes?

P: It's about, it's been uh seven years now.

D: OK, any hospitalizations or surgeries in the past?

P: No.

D: OK and um how about medications? Are you on any?

P: Uh yeah, I've been taking uh metformin for the past uh, for the past five years, when, five or six years.

D: OK.

P: Um and uh my family Doc started me on uh ramipril about two weeks ago, he told me that uh now that I'm 50, I need to I need to be on this pill as well, so now I have to take 2 pills instead of one.

D: OK.

P: Yeah because I think it's it's good for my heart or something.

D: Yeah, for sure. So you started that two weeks ago, OK. Are you up to date with all your immunizations?

P: Uh yeah, I think so.

D: OK, any allergies?

P: Uhm penicillin, I just get uh I get a rash. I got a rash when I was a child, I haven't had it since then.

D: OK, OK. Any family history of lung or heart conditions?

P: Uh no, nothing like that.

D: No, OK. Do you smoke?

P: Uh, no.

D: No, how about, uh, marijuana or other recreational drugs?

P: No.

D: No, OK, um alcohol?

P: Uh yeah, I drink on the weekends.

D: OK, what do you drink and how much do you drink?

P: I'll have maybe two or three uh bottles of beer.

D: OK sure, and um have you been in contact with any sick people recently?

P: No, no, I've just been staying at home.I'm just scared of covid, but I'm I'm still worried I might have somehow gotten it.

D: Yeah, for sure. Uhm, any travel recently?

P: No.

D: No, OK. And where do you live right now?

P: I live in a house with my wife and my two kids.

D: OK, uh are they healthy?

P: Yeah, they're all healthy.

D: OK. Any old carpet, dust, mold, or asbestos in your home?

P: Um not that I'm aware of.

D: No, OK. OK, well it seems like um those are all the questions that I had for you today. Did you have any questions of your own?

P: Uh no, I just want to get tested for Covid.

D: Yeah, so we will definitely do a Covid swab on you because you have a cough, um and those results should come back to you in about 24 to 48 hours, and so you'll know more then. But because your symptoms do overlap with that of Covid, we still recommend isolating for 14 days. But the other thing I want to mention is that you don't have any other symptoms of infection besides your cough, and it seems like the cough started a week ago and you started this new medication ramipril two weeks ago, and so ramipril is a type of ACE inhibitor and one of its side effects is that in some people it can cause coughing. So, I am going to review your medications and if your family Doc also agrees, we may try uh another um blood pressure medication for you instead of ramipril.

P: Sure.

D: Um so we'll try and change that medication and see if your coughing stops. How does that sound?

P: Sounds great.

D: OK, great, thank you.


D: What brings you in?

P: Hi, uhm, I've just been a little bit worried, that last the couple of months I've noticed that I've been getting more and more out of breath when I've been doing exercise, and I know I got a brother who had a heart issue and I'm just really concerned that I have something wrong with my ticker, just wanted to get it checked out, you know?

D: Uhm, when did the shortness of breath start?

P: So, this winter specifically, like we haven't been too active because of Covid this year, we've just been staying in the house all last year, but with the snow, I'd be shovelling snow whenever it fell and before I could be able to like 2 years ago be able to clear the driveway, no problem, but now even after half the driveway I've noticed I'm getting consisntely out of breath, I've got this nasty cough and it's prompted my wife to get me to call in, she's a little bit worried.

D: So it's mostly on exertion, it doesn't happen at rest, is that correct?

P: Being out of breath? No, no.

D: No, OK, ok. And has this ever happened to you before?

P: Yeah, about a year and a half ago we went down to Toronto, in order to see the CN tower, and you know, do tourist stuff and we tried we tried to climb a couple flights of stairs to do a little bit, and I could not, I always thought I'm pretty healthy, pretty active but it really took the wind out of my sails, so had to stop, stoop over. Just couldn't do it.

D: Uhm, and how did you manage like how, how was that treated at that time and how did you get better?

P: Oh, I didn't do any. I just attributed to being, I don't know, out of shape a little bit and I worked as a mechanic when I was younger. I was pretty active, but ever since retiring thought I'd keep up, at least my stamina won't go away that quickly, but chalked it up to being out of shape and went home.

D: OK. Uhm, so your symptom, your shortness of breath seems to be getting worse, right?

P: Yeah.

D: OK, any coughing with that?

P: Yeah, yeah. And not necessarily when I noticed it when I was shovelling the driveway. But I've had a call for the last couple of years and usually in the morning I just bring up a little bit of gunk, but most of my buddies have that, just like a morning cough, you know?

D: Yeah, and the gunk that you bring up. What color is it?

P: Uh, yellow, sometimes a little brown.

D: OK, and when did that start?

P: Oh, it's been going on last 10 years. Well, to be honest since I've been like 30, but it's been fairly consistent, last 10 years I'd say.

D: OK, any blood that you bring up?

P: Not that I've noticed, like bright red? No, nothing like that.

D: OK. Any wheeziness?

P: Yeah yeah, I noticed that when I was showing, yeah when I was out of breath, it sound sounded different sound different than being usually out of breath but it had to. It sounded wheezy.

D: OK. Any chest pain?

P: Yeah, a little bit actually.

D: Uhm, at rest or?

P: Nothing, nothing when I'm not moving.

D: OK, so the chest pain, when did that start?

P: First noticed it this winter on the driveway but it wasn't like I know what they say about a heart attack, supposed to like, the crushing pain in your chest that moves up your neck. Nothing like that. It's like my lungs, my throat. Like you're really, really out of breath, you know?

D: OK, so you're attributing it mostly to your shortness of breath then?

P: I think so. I really hope this is my heart. I've never had a heart attack.

D: Yeah. Where in your chest is this chest pain happening like is it central? Is it more towards the left, towards the right?

P: It was kind of both sides.

D: OK.

P: It was, Was we all across my chest, to be honest it was only the one time that was really struggling and I coughed up a bit, but yeah.

D: OK, any pain in your calves or legs, well after you walk a certain distance?

P: No, no.

D: No. Do you ever feel like your heart's racing?

P: Felt like my heart was racing after that much activity, but no, not usually.

D: OK. How about swelling in your limbs?

P: No, nothing like that.

D: OK, any fainting spells or dizziness?

P: No never fainted in my life.

D: OK. Any confusion, memory loss?

P: No, nothing like that.

D: Headaches?

P: Headaches, you know I do get headaches from time to time. I associate them with stress, but I haven't been too stressed out recently so nothing in the last couple of years.

D: OK, any neck stiffness?

P: Uh, no.

D: No, OK. Any sensitivity to light or loud sounds associated with that headache?

P: No, nothing like that.

D: OK, any weight loss?

P: No, I wish.

D: OK. Fevers?

P: No.

D: Rashes?

P: You know I got these weird things on my head. I think mainly because of the sun. Like these brown patches, but that wouldn't be a rash, would it?

D: I'd have to examine that closer. If you think it's associated with the sun, it could be something like seborrheic keratosis, but I'd have to see what they look like so we can take a look at that later, if that's OK. And so any changes in your vision or hearing?

P: No.

D: No. Stuffy nose, runny nose?

P: Had a bit of a cold couple months ago, but no, nothing recent.

D: Sore throat?

P: Yeah, a little bit after the cough. I had a little bit of a sore throat but went away pretty quickly.

D: OK. Change in smell or taste?

P: I haven't been able to smell or taste too well for awhile.

D: What's awhile?

P: Ten years, seven years it's been more salt, more spices on my food, you know.

D: OK, OK. Any changes to your bowel habits?

P: Nope, been regular all my life.

D: Nausea, vomiting?

P: No.

D: OK. Joint pain, muscle aches?

P: You know my knees been giving me trouble for awhile, but nothing recent, no.

D: OK, and are you otherwise healthy?

P: No, got high blood pressure. See the doc about that. Uhm, high cholesterol, see the doc about that. And yeah, I don't know. Got into a car crash my 40s. Broke my arm one time. Nothing else really.

D: OK, any surgeries?

P: Uh, I think I had my appendix out when I was, yeah I had my appendix out when I was like 12.

D: OK.

P: Never been under the knife since then.

D: OK, great. Have you been taking any medications for that high blood pressure?

P: Yeah doc's got me on two blood pressure medications and one cholesterol medication.

D: OK, and do you take those frequently?

P: Yeah, everyday.

D: OK, good. Any other medications?

P: No.

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

P: Jeez, been a while since I've gotten immunization. Think, I think so.

D: OK. Once you turn 65, they usually give you shing-shingrex for, to prevent shingles and a pneumovax vaccine to prevent pneumococcal infections. Have you had those ones?

P: Nope.

D: No, OK. So if you're interested in getting those, we can discuss that at some point today as well,

P: OK.

D: Do you have any allergies?

P: No.

D: No, OK. Any, OK, so you mentioned a family history of your brother having congenital heart disease. Any other heart diseases that run in the family?

P: Congenital. What's that mean?

D: Like something that you're born with.

P: No, I don't think he's ever born thing he had a couple of heart attacks.

D: Oh heart attacks. OK sorry I must have misinterpreted that. How old was he when he had his first heart attack?

P: He's older me by five years, but he had the first one when he was younger than I am now. Like 62 was the first one, another one at 65.

D: OK. Uhm, did, is he, did they ever find a cause for his heart attack? Is he a healthy person?

P: Healthy, he's healthy. I you know I wouldn't call him too healthy of a guy either. He's a hard liver, let's call him that. I have why it happened, I think, obviously it's his diet man. He's like a hog. Steaks, butter, bacon I'm  assuming that's what did him in.

D: Oh yikes, OK. OK, uh any other heart conditions that run in the family or other members of the family experiencing heart attacks?

P: Yep, dad died young from a high heart attack. He was, he died younger than I am now. He passed away at 66.

D: Oh, I'm sorry to hear that.

P: Oh it's been years now. It is what it is. His grandmother had a stroke. High blood pressure on my mom side. High cholesterol on my mom side too. But yeah, awful heart attacks on my father side of the family.

D: OK. Any other lung, any lung conditions that run in the family?

P: None that come to mind.

D: OK and do you smoke?

P: Yeah, yeah I smoke.

D: OK, how much do you smoke?

P: I cut it back, about half a pack a day for the last two years now.

D: OK and before that?

P: I was pretty much a pack a day. Maybe, well, when it was bad, 2 packs a day, but I've been smoking yeah, since about, when do they start working at the shop, like 17, everyone there smokes.

D: Oh OK Wow yeah well then but it's good that you cut down, that's good. Do you, do any other recreational drugs like marijuana, cocaine, heroin, anything?

P: I'll smoke weed at the shop every Friday, but I'm not huge fan of it to be honest.

D: OK. And how much do you smoke every Friday?

P: Both are about four joints, seven people, so I don't know what that is. Half a gram?

D: Half a joint? OK, yeah. OK, and do you drink?

P: Oh yeah.

D: How much do you drink?

P: See, Christmas was about the last time I went out like a beer or two. Uhm, weekends but when families in town will we'll go whole hog. I'll drink maybe 20 beer.

D: Oh OK, OK. And yeah you should, have you thought about cutting that down?

P: You gotta keep up with the family, you know, you can't let them embarrass you like that.

D: Let's, I understand that, but also you know, it's important to take care of your health and slow and steady wins the race, right?

P: I'll keep that in mind, doc, I'll keep that in mind.

D: Yeah, and how's your diet?

P: Been pretty good. The wife's been on a, on a health food craze last five years. Vegetables, I don't know, I eat whatever she cooks, basically.

D: OK. Uhm that's good, and in terms of exercise, do you get to move around?

P: I used to be pretty active. I used to bike around, but 'cause of Covid I've just been indoors all this time. So no, not much.

D: OK. OK, well it's good to go out for a walk once in awhile. I think that's allowed during Covid as long as you're being safe. And who do you live with at home?

P: I live with my wife.

D: OK, any children?

P: Yeah, I've got three kids, one for my first marriage, two with the Mrs. right now.

D: OK, and do you get to see them often?

P: Yeah, daughter lives in town and get to see her and grand kid a bit, the other boy works in Fort Mac and my oldest son, he's out east.

D: OK, OK, and have you had any contact with people who've been sick recently?

P: No, we've been keeping entirely to ourselves. You can get our groceries ordered to the house.

D: OK. And how about travel? Any recent travel?

P: No.

D: No, OK. Uhm, and then lastly, just wanted to ask you because you have been smoking for a long time, have you ever been diagnosed with something called COPD?

P: Doesn't ring a bell.

D: No, OK. Have you ever had any pulmonary function tests or chest x-rays done in the past?

P: Chest x-ray, I think they did a chest x-ray after the car crash.

D: OK.

P: But I can't think of getting one recently, no.

D: OK. Alright well those are all the questions that I had for you. Did you have any questions for me?

P: So this is a hard, like, should I be worried?

D: Yeah, you know what? It sounds from what you're telling me, it sounds like you have shortness of breath on exertion, and it sounds like you have a cough with still producing some phlegm. It doesn't seem like you have any systemic symptoms of infection, so I'm not too worried about that. And then in terms of your heart, you mentioned you had that chest pain once, but it really does sound more like a lung problem to me than a heart problem to me right now, but of course we'll do all the necessary investigations to rule out any heart stuff. But right now, I'm thinking it could be something called COPD, chronic obstructive pulmonary disorder because of your smoking history. Uhm, so we'll start with doing a pulmonary function test and chest x-ray, and I we'll try to go from there. If it is COPD we'll likely put you on a, like a puffer for that. A like a lot a short or long acting beta agonist, that's what it's called. So if your symptoms don't get better with that, we'll do other investigations to try to figure out what this is. How does that sound?

P: Sounds great, doc. Thanks a million.

D: Alright, great thank you.

P: Have a good one.


D: What brings you in?

P: Yeah, nice to meet you I, I've been having just over the last week my cough that's been getting worse and I had a fever a couple of nights and just yesterday I noticed that I started having a loss of taste and smell so that got me really worried.

D: OK, so yeah, let's rewind a little bit. The cough you said started a couple of weeks ago, so would that be about 2 weeks? Three weeks?

P: I would say last week, so like 7 seven days ago.

D: Seven days ago, OK. So that started seven days ago and then when did the fever start?

P: The fever I hasn't been constant, but I've like had some nights where I just feel really chilly and then during the day sometimes even getting these chills I've been recorded at a temperature, but I think I've had a fever at least three times in the last week.

D: OK, so you haven't actually taken your temperature, but it you just feel like you have chills?

P: Yeah.

D: OK, we could take your temperature today. And then the loss of smell and taste. Do they both happen at the same time?

P: I think the taste happened like before, but that was just yesterday and then yesterday morning like at breakfast, I couldn't really taste anything and then continued during lunch and dinner, but smell, I kind of lost around the evening.

D: OK.

P: Yeah, all just started yesterday.

D: OK. Um alright, so let's go back to the cough and has it been constant since it started?

P: Yeah, it's been pretty constant. It's been getting worse, especially like in the last few days. I'm mainly coughing like before I was coughing mainly at night, but now I'm coughing throughout the day.

D: OK, um so yeah, you mentioned possibly a trigger would be like time of day at night? Or did you notice any other triggers like you know, the cold air or dust or anything at home that could be potentially triggering your cough?

P: Uh no, not really. Like I've lived in the same place for awhile, no new changes and I've been barely going outside, so I don't think there are any triggers.

D: OK, and in terms of the quality of your cough is that, would you say it's harsh? Barky?

P: Uhm, I would just say it's like kind of harsh at times, but mainly it's a dry cough, like I'm not bringing anything up.

D: OK, OK. And then you said dry cough so no sputum or blood right?

P: No.

D: OK. Have you ever experienced anything like this in the past?

P: Not the loss of taste and smell, but like the other stuff when I just had a cold or flu like symptoms previously, but the taste and smell is something completely new.

D: OK. And then, um, have you experienced any shortness of breath?

P: Um, not really, no.

D: No, OK. How about we wheeziness?

P: No.

D: Chest pain?

P: No chest pain.

D: OK. Uh, experienced any weight loss recently?

P: No, not that I know.

D: OK, how about fatigue?

P: I have been a bit tired in the last few days. The fevers at night and morning. Just feeling a little bit crummy, just not really energetic, energetic to do anything.

D: Yeah, for sure.

P: Just been planner, just sitting on the couch.

D: OK. Any changes to your hair, nails, or skin, like rashes?

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

D: OK, you mentioned loss of smell. Do you have a runny nose or a stuffy nose?

P: I did have a runny nose earlier this week, but that's kind of subsided. Other than that, I don't really feel too much congestion. I've been taking Tylenol, the Tylenol cold so I don't know if that helped.

D: OK, how often are you taking the Tylenol cold?

P: I just took it like for four days just before going to sleep in the last week.

D: Oh, I see. OK. OK and then. Any I do have a sore throat?

P: No.

D: No, ok. How about any changes to your vision or hearing?

P: No, nothing like that.

D: Any pain or discharge in the eyes or ears?

P: No.

D: OK. Do you ever feel like your heart's racing?

P: Uh no, not really.

D: No, OK. And any swelling in your limbs?

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

D: OK, any dizziness or fainting spells?

P: No.

D: OK. Confusion or memory loss?

P: No, not that I can tell.

D: OK, any changes in your bowel habits like constant constipation or diarrhea.

P: Oh no, not really.

D: No, no blood in the stool, right?

P: No.

D: OK, any changes to your appetite?

P: Um, just maybe in like a little bit with the loss of smell and taste, the food is not really the same in the last day, last few days?

D: Yeah yeah, that makes sense. Any nausea or vomiting?

P: No.

D: No, OK. And any changes in terms of urine?

P: No, I've been peeing alright.

D: OK, good. Any major or a longstanding medical conditions, or are you otherwise healthy?

P: No, I've been fortunate otherwise healthy. I had asthma as a kid, but like I haven't had to use the puffers for more than a decade.

D: Oh ok. OK. And what triggers your asthma?

P: I think back then it was just when I did sports and I was running around a lot. I've been fine for the last 10 years at least.

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

P: No.

D: No, OK. Any are you on any medications?

P: Currently just the other thing, Tylenol cold, but other than that no other medications.

D: OK, not even other over the counter medications or herbal supplements?

P: No, nothing like that.

D: OK. Do you have any allergies?

P: Um, sometimes in the fall like I get a bit sniffly and, but other than that, I don't know of any allergies to any foods or medications.

D: OK. And how about immunizations? Are you up to date?

P: Yeah, they're all up to date.

D: Any lung conditions or heart conditions that run in the family?

P: Uh, my father did recently have a heart attack at age of 58 I think he was, he, he's fine though, but that's that's about it.

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

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

D: OK. And, and do you smoke?

P: Uh, yeah, yeah I do.

D: OK, how much do you smoke?

P: Probably, I would say a pack a day.

D: Pack a day, OK. For how long?

P: Ah, probably since in my 20s, so at least 10 years now.

D: OK, have you ever thought about cutting down?

P: Yeah, especially with this pandemic going on, it's been, I've been trying to cut down just because like I don't want to get the, get COVID and then you know my lungs are probably already weaker because of the smoking. So I've been trying to cut down.

D: Yeah, for sure it's good that you're trying to cut down. We have resources to help you if you ever need them.

P: Yeah, for sure.

D: Do you do marijuana?

P: No, no, I've never tried marijuana.

D: OK, how about other recreational drugs?

P: No, um, besides alcohol, nothing else.

D: OK, and then um, I guess I'll ask you about the alcohol, uhm, how much do you drink?

P: Um, um, not that much. I'd probably say like a few times a week when there's a game on. I just grab a couple of beers, but that's about it.

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

P: Yes, I just live just outside of London with my wife and daughter in a small townhouse.

D: OK and anyone else at home sick?

P: No. I I've kind of stayed away once I noticed some symptoms. I'm just kind of just staying in my room, not getting out. I don't wanna make any of my families like.

D: Yeah, that makes sense. And have you traveled to anywhere recently?

P: No, umm, I haven't really traveled. I do I do go to work though I haven't in the last last week. I've told them that I've been having these symptoms, but other than that, no traveling.

D: OK. Uhm, OK, that's good. Those were all the questions I had for you today. Was there anything that you wanted to ask me or anything else that you wanted to discuss that I may have missed?

P: Uh, yeah, I I that I'm just wondering like I could it be COVID I I don't know. I don't know if someone in the office had it or yeah, it was just basically worried about, if I had COVID.

D: Yeah for sure. that's definitely something that we need to rule out, so we will be doing a COVID swab on you and and you will hear back in about 24 to 48 hours with the results. But regardless, because your symptoms overlap with symptoms of COVID especially umm, the loss of smell and taste, we do recommend that you isolate for 14 days and that includes trying to isolate from family members as well. So we'll, that's where we'll start. If it's not COVID, it could be another viral illness that's going around at this time of year. But, we'll start with, we'll start with these COVID swabs. How does that sound?

P: Yeah, that sounds good. I'll, I'll let my work know and yeah, hopefully it comes back negative, but I'll stay away from everyone till then.

D: OK, sounds great, thank you.

P: Alright, thank you so much.


D: How may I help you?

P: So I've been having a lot of trouble in the last two weeks of especially this past week of just a lot of shortness of breath. I'm getting a lot of coughing as well and producing a lot of material. And also I think I might have been having a fever this week as well.

D: OK, uh, the shortness of breath is it happening at rest or exertion and how much exertion?

P: Uhm, I think it's happening mostly on exertion. Usually I'm able to walk around the house, no issues, go up and down stairs, but right now I'm pretty limited. I can't really go up and down stairs without getting really short of breath. I can't even walk from the bedroom to the kitchen without becoming shortness of, like short of breath.

D: OK, um OK, and when did that change happen?

P: So I would say one week ago is when this all kind of started.

D: OK, and has it been getting any better, worse, or staying the same?

P: I would say it's kind of getting worse. I'm coughing a lot more sputum up. I'm getting more and more short of breath. Now, I do have a call for like a very long time now I've I was diagnosed with COPD in my 60s. Probably like 10 years ago and but this seems to be just a much worse than my COPD.

D: OK, sure it's been a lot worse in the last week it sounds like. OK. Uhm have you, are you able to lie flat? Like on your back without experiencing shorter breath, shortness of breath?

P: Yeah, and when I'm resting or lying down or trying to sleep I don't get short of breath.

D: OK, and have you ever had instances where you woke up in the middle of the night really short of breath and you had to sit up to catch your breath?

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

D: OK, have you noticed any leg swelling?

P: No.

D: OK, and you said that to you, so you've had a cough for awhile now, but it's gotten worse. This past week in your, are you bringing up sputum?

P: Yeah, I'm bringing up a lot of materials. I think every time I cough I'm bringing some sputum up and right now the like usually the color is like clear to whitish but right now it's a bit more yellow.

D: OK, so a change in the sputum color and also sounds like you're bringing up more sputum as well.

P: Yeah.

D: OK and have you brought up or coughed up any blood? So have you had any hemoptysis?

P: No, nothing like that.

D: OK, and have you had any wheezing?

P: Uhm, I do but when I get short of breath I have some wheezing, but usually I don't.

D: OK, but but you've had wheezing this past week though.

P: Yeah.

D: Yeah OK. And have you had any chest pain?

P: Just when I'm coughing and getting short of breath, I do have some discomfort in my chest.

D: OK, uh, do you feel that, or could you describe he the pains character? Like is it sharp, dull, or achy?

P: It's more just an ache and it's kind of more of a discomfort than a pain, and it kind of goes away once my episode of coughing and shortness of breath is relieved with some rest.

D: OK. Uh, and uh, have you been experiencing any fevers or chills?

P: Yeah, I've been noticing that I'm getting a lot more chills this past week. They kind of come and go, but even at night I get like these chills that after wrap myself up in at least three blankets.

D: OK, and have you had a fever?

P: Uh, I didn't get a chance to measure any of them, but I might have had a fever just from the chills that I'm expecting that I had a fever.

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

P: No.

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

P: No, I think my weights been pretty steady.

D: OK. Have you had any headaches?

P: No.

D: Have you had any like eye redness or eye discharge?

P: No, not that I know of.

D: OK, have you had a runny nose or a sore throat?

P: No.

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

P: No, nothing like that.

D: OK. Have you had any nausea or vomiting?

P: No.

D: Have you had any abdominal pain?

P: No abdominal pain.

D: Have you had any diarrhea?

P: No.

D: Have you had any constipation?

P: No.

D: Have you had any skin rashes?

P: No.

D: Any muscle aches or joint pains?

P: No, nothing like that.

D: OK, and have you had any any fatigue?

P: Maybe a little bit more tired just with the shortness of breath and chills and everything like that, but yeah, so a little bit more fatigue.

D: OK, and have you had any fainting or dizziness?

P: Uh, no.

D: Or, OK and have you had any heart palpitations?

P: Nope.

D: Alright. And have you been diagnosed with any medical conditions in the past?

P: No. Oh sorry, medical conditions in the past? COPD I have. I also do have some high blood pressure and I take some medications for cholesterol as well.

D: OK, so you take medications for cholesterol and high blood pressure and you use any inhalers?

P: No. Sorry, inhalers I, use, uh, two different kinds of inhalers. So one of them is just when I like need it, uh, like I've been using a lot more recently, like the Ventolin. And then I also have another inhaler called Spiriva that I've been using as well.

D: OK, and do you have any allergies?

P: Uhm I do have an allergy to sulfa drugs.

D: And what reaction?

P: I usually break out into hives.

D: OK, and any prior surgeries or hospitalizations?

P: So I've had a surgery to remove my appendix when I was really young. Then I've had another surgery for my hips as well, but yeah, other than that, no other issues.

D: OK. And are your immunizations up to date?

P: Yeah, all of my immunizations should be up to date.

D: OK, excellent and could you tell me a little bit about where you're living currently and who you're living with?

P: Yeah, so I, I currently live alone in, in an apartment just in the city. And yeah, I've been living alone for probably the last five years.

D: OK, and have you been around anybody who's been sick?

P: Uhm, not recently. I think I just I just go out to get groceries and stuff. I haven't really been going out too much.

D: Alright, So have you traveled anywhere?

P: No.

D: OK uhm, do you drink alcohol?

P: Maybe a couple of years a week.

D: OK, and do you smoke cigarettes?

P: Yeah, I still smoke cigarettes. Even though I have COPD, I just yeah, I can't really quit. I smoke probably half a pack a day.

D: OK, how long have you smoked for approximately?

P: Uh, probably at least 45 years.

D: OK and uhm, if you wanted to talk about quitting, we can discuss that further at a later time if you'd like. Uhm, and so do you use any recreational drugs?

P: No, no no no drugs at all.

D: OK. Uhm, and have you had a family history of heart disease or any lung conditions?

P: Uhm, not, I mean like no lung conditions, but I have a family history like my both my grandather and father both had heart attacks in their 60s.

D: OK, and any lung cancer in the family?

P: No, not that I know of.

D: OK. So I think that was all the questions that I I wanted to ask today. Was there anything else that I maybe forgot about that you wanted to mention?

P: Uhm no, I think that those are all the questions I had and everything was covered.

D: OK, uhm so uh, the next steps for now, I think, will be to, uh start, we'll get a physical exam in and your vital signs and get some investigations. It is sounding like a COPD exacerbation with the increasing and the change changing sputum. The increasing frequency of cough and the exertional shortness of breath as well, along with wheezing and kind of this chest discomfort that you're experiencing. And so, uh, this will require some antibiotics as well and depending on the severity of symptoms, possibly some steroids as well to help with the inflammation.

P: OK, that sounds good. Thank you.


P: I've just been having this this cough over the last few days and I also notice that I'm getting like these headaches and chills as well at night. So I was just a bit concerned.

D: OK, so the cough started a few days ago. Have you been bringing up any phlegm?

P: No, not really. It's been pretty much like a dry cough. I did feel like a tickle in my throat before it started, but no, I'm not producing any phlegm.

D: OK, um is the cough any worse at any particular time of day, like when you first get up or or at night when going to bed?

P: No, it's pretty much just been there over the last, at least like 2 days. It's been getting worse, more frequent.

D: OK, so um and are you coughing all throughout the day?

P: Pretty much, at least for the last few days. Just it's been pretty nonstop.

D: OK, anything that's made the cough worse?

P: Uh, no, not really. It's uh, pretty much been the same for the last few days.

D: Anything you've tried to make the cough go away?

P: Just like Tylenol cold. And then I think there was another over the counter medication that I took, but nothing really helping.

D: OK and uh, the cough has been been getting worse. Have you been experiencing any other symptoms?

P: Um, I did just just last night, actually. I thought that I had some shortness of breath as well. I don't know if that's being caused by all the coughing, but yeah, I got pretty scared, so that's why I'm here today.

D: OK, um has anything like this happened to you before?

P: No, like I've been pretty healthy otherwise completely so this is this is completely new for me.

D: Ok, and yeah, you mentioned you had a fever but did have you checked your temperature?

P: No, I haven't I I just had like chills over the last two nights. Just had to put on like 3 three blankets just to get to sleep, but I haven't really checked my temperature.

D: OK, I have you had night sweats?

P: No, not really, just mostly chills.

D: OK, and how has your energy been the last few days, have you have you had a lot of fatigue?

P: Yeah, I just feel completely just sick like what it feels like I have the flu or something and I just feel really tired too.

D: OK, have you had a runny nose or sore throat?

P: No, not really. I did have like a I don't know if it was soreness, but just like a tickle in my throat just a few days back before the coughing started.

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

P: Yeah, now that I think of it, I I I I can't I can barely taste taste the food that I'm eating. I don't know about smell I I'm pretty stuff stuff stuffy right now so that might just be because of that. I definitely notice I can't really taste my food.

D: Alright. Uh, and uh, have you been having any wheezing?

P: No, no wheezing.

D: Alright, and shortness of breath, were you at rest when that that happened or were you exercising or exerting yourself? What, how did the shortness of breath come on?

P: I was actually just laying down and I was sleeping and I just noticed that I couldn't really take deep breaths, so I kind of just got back up and it was just during last night. It hasn't happened after that, but I'm scared it will happen again.

D: OK, and have you, how many pillows do you usually sleep with?

P: Just one.

D: Have you noticed any swelling in your feet or ankles?

P: No, nothing like that.

D: Alright, have you had any chest pain?

P: No, no chest pain.

D: Any feeling, any episodes where you feel like you were gonna faint?

P: No.

D: Feeling like your heart's racing?

P: No.

D: Alright, um, have you been having any abdominal pains?

P: No abdominal pains.

D: Alright, how about urinary problems?

P: No, nothing like that.

D: Any bowel problems like diarrhea?

P: No, it's pretty regular.

D: OK, have you noticed any rashes anywhere?

P: No.

D: Alright, and then how about like muscle aches or or joint aches?

P: No, nothing like that, just feeling tired.

D: OK and then have you had any changes to your vision?

P: No.

D: Like blurred vision or things like that?

P: No, nothing like that.

D: Any changes to your voice, like it sounds more hoarse to you or?

P: No, not really.

D: Oh, OK, and any nausea or vomiting?

P: I did feel a bit nauseous over the last two days, but I haven't vomited.

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

P: No, I've been pretty lucky. No medical conditions. I don't even take any medications either.

D: OK, anything over the counter like supplements or herbal?

P: No, just just the cold medications over the counter, nothing else.

D: OK, any allergies to medications?

P: Not that I know.

D: Any hospitalizations?

P: No.

D: Have you had any prior surgeries?

P: Nope.

D: OK, um, and could you tell me a little bit about your living situation now?

P: Oh yeah, so I just live in a townhouse with my wife and two children. And yeah, currently, working as an engineer. Yeah, pretty everything else is pretty good.

D: OK, um have you had to miss work over the last few days?

P: Yeah, I actually didn't go to work yesterday, just felt terrible yesterday.

D: OK how have the wife and kids been feeling at home?

P: They're actually completely fine now. They don't seem to have any any symptoms of like coughing or anything like that.

D: Anybody at work that's been sick?

P: There was actually like just we work in the same kind of office setting. One of my coworkers was coughing just last week and like you know, my boss told us, told him to like, go home and get some rest and he was away for a couple days.

D: OK, uh, do you know what um what he had or anything like that?

P: No, I'm not really sure. Now that I think of it, like I I don't I haven't seen him since. Uh, so I haven't really asked him. Yeah, I'm not really sure.

D: OK. Has have you traveled anywhere, or has anybody in your office been been traveling anywhere?

P: No, not really. Not that I know, everything is pretty strict right now with with the pandemic going on.

D: OK. Um and yeah, do you smoke cigarettes?

P: No.

D: Do you drink alcohol?

P: Just rarely, maybe a couple times a month.

D: OK, do you use recreational drugs like IV drug use or opioids or crystal meth, anything like that?

P: No, nothing like that.

D: OK, and are you currently sexually active?

P: Yep.

D: OK, could you tell me a little bit about your your partner or partners?

P: Just my wife, no other sexual partners.

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

P: Nope.

D: OK, and so in regards to your family history, has anybody had similar symptoms before?

P: No, not really. Not nothing like this.

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

P: No.

D: OK, and then how about so any cancers in the family?

P: I think I've had an aunt who had breast cancer but nothing else.

D: OK, um, so those are all the questions I wanted to go go through on history. I am concerned that you might might have COVID-19 or coronavirus. And so it could be COVID, or this could be another viral infection or possibly pneumonia going on. But it does sound like you have an infection and so we'll check some sputum cultures. And and we'll also do a PCR nasal swab testing for COVID. So we'll go ahead and order those tests and we'll see what their their results say.

P: Alright, sounds good.


D: How may I help you?

P: Hi there, umm, so I've had this runny nose for the past five days and it doesn't seem to be going away so I thought I should get some help.

D: OK, and ah, with the runny nose, could you describe the discharge?

P: Yeah, it's, it's pretty clear.

D: OK, and have you had any nasal obstruction or feeling as though like one of your nostrils is plugged when you're breathing in?

P: Uh yeah, I have that feeling.

D: OK, have you had any pain on your face?

P: Pain? Ah no, nothing like that.

D: OK, how about a change to your sense of smell? Like loss of smell?

P: No, I haven't had that.

D: OK. Have you had any discharge from your eyes or eye redness or any eye pain?

P: No.

D: Alright, have you had a sore throat?

P: Uhm, no sore throat.

D: Have you had a cough?

P: No.

D: OK. Have you had any headaches?

P: Ah, just a slight headache.

D: OK, I mean, have you experienced headaches like this in the past?

P: Yeah, usually when I get sick, I get get a headache.

D: OK. OK, can you describe where you feel the headache the most and is it pulsating or kind of always there?

P: It's kind of always there and it's just on the sides of my head.

D: OK, have you tried anything for it?

P: Just some Tylenol, which seems to have helped.

D: OK. Uhm, and umm, yeah, have you had a cough?

P: Ah no cough like now, uhm, I I did have a slight cough last week.

D: OK, and it went away?

P: Mhmm.

D: Was it dry or did you were bringing up any sputum or phlegm?

P: No, it's pretty dry.

D: OK. Uhm, and do you have a sore throat?

P: No.

D: OK, and have you had any wheezing or shortness of breath?

P: No.

D: OK, and have you had any chest pain?

P: No.

D: How about any we, sorry, fainting or dizziness?

P: No, nothing like that.

D: OK, have you had any heart palpitations or feeling like your heart's racing?

P: No.

D: OK, uhm, and have you had any abdominal pain?

P: Uhm, I have had some, like diarrhea so I think part like my stomach hurt a little bit during that time, but I don't have that anymore.

D: OK, when did you have diarrhea?

P: Last week as well.

D: OK. Uh, was there any blood in the stool?

P: No.

D: OK, have you had any changes to your urinary habits? Like any pain or frequency?

P: No.

D: Alright, and have you had any nausea or vomiting?

P: No.

D: How about any fevers or chills?

P: Uh, no.

D: Have you had any night sweats?

P: Uh, no, nothing like that.

D: I see, OK. And have you had any weight loss recently?

P: No.

D: Alright, have you had any rashes or skin rashes?

P: No.

D: And how about any muscle aches or or body pains?

P: Oh, no.

D: Alright and how has your energy been? Have you had fatigue?

P: Uhm, a little bit.

D: OK, little fatigue and and how has your appetite been?

P: Appetite's been OK, I'm still eating.

D: Alright. And, uhm have you been diagnosed with any medical conditions before?

P: Uh, no, I've been pretty healthy.

D: OK, great and so do you take any medications regularly, either over the counter or prescribed?

P: No.

D: OK, and do you have any allergies?

P: No, I don't.

D: OK, and any recent hospitalizations in the past or any prior surgeries?

P: Uh, no. Actually, I had my appendix taken out when I was younger, but that was a long time ago.

D: OK, I see. And are you living, ah, can you tell me about where you're living now and who you're living with?

P: I'm I'm living by myself. I'm a student. I live in an apartment.

D: OK, and are you going to classes in person right now?

P: No, they're all online.

D: OK. And have, have you been around anybody who's been sick?

P: No, not that I can think of.

D: OK, and have you traveled anywhere recently?

P: No.

D: OK. And you smoke cigarettes?

P: I don't.

D: And do you smoke cannabis or use any cannabis products?

P: Occasionally, I will.

D: OK, how often?

P: Uhm I will maybe smoke once a week.

D: OK, uh, and use any recreational drugs like cocaine or opioids?

P: Oh gosh, no.

D: And do you drink alcohol?

P: Uh yeah, occasionally.

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

P: Uhm, I'll have like a bottle of wine a week.

D: OK, and are there any heart or lung conditions that run in the family?

P: No.

D: OK. How about any cancers?

P: I think like colon cancer runs in the family.

D: OK, umm and alright so that was everything that I think I wanted to ask about on that on the history today. I was wondering if there was anything else that you wanted to mention that I maybe forgot to ask about?

P: No, nothing else I I I was just wondering what I could do to feel better or make this go away.

D: Yeah, certainly. So, I, so it's sounds like you have the common cold or a viral illness, which it could be caused by something like adenovirus or there are others as well. However, the symptoms do overlap with COVID. As you can be like nonspecific symptoms, such as having kind of just like a runny nose like you do here, and so we will do a COVID swab and we'll await those results, but in the meantime it's mostly supportive care, so it means just trying to stay hydrated, stay rested. And just monitor your symptoms because if things do get worse, it'll be important to, uh, go to the emergency room.

P: OK.

D: Alright, so we'll get the swab now and get that testing started.

P: OK, that sounds great, thank you.

D: Alright, thank you.