D: How are you?

P: I'm doing OK. Thank you. How are you?

D: I'm well thanks. What brings you in today?

P: So, usually we go to my favorite pizza spot for lunch and these last couple of days I've noticed I just can't taste it.

D: OK, when you say the past couple of days, do you mean two days, three days, four days?

P: I would say the last two days, yeah, just yesterday and today.

D: OK, so loss of taste, so you can't taste anything or you can only taste some things or you're just not getting the full depth of your taste?

P: Yeah, I really noticed it with the pizza, but with like other things too, it's just a yeah, really plain, it doesn't  really have any flavor with the food that I'm eating.

D: OK, so it kind of tastes like cardboard.

P: Yeah, kind of, and I think, like, I mean part of that is that I maybe not smelling it as well either.

D: Yeah, OK. Umm, did you have any trauma to the area like the mouth area or the nose area in the past couple of days or days leading up to that?

P: Umm, no, not at all, no.

D: OK and do you have a fever at all?

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

D: OK, you have a cough?

P: Yeah, I've had a cough.

D: OK, a similar timeline?

P: Yeah, that's when the cough started, maybe three or four days ago.

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

P: Yeah, it's a dry cough.

D: OK, so no sputum, no blood?

P: No sputum and and no blood.

D: And do you feel wheezy at all?

P: No wheeziness.

D: How about shortness of breath?

P: Umm, maybe after coughing, I've had a hard time catching my breath.

D: OK, sure, yeah. And how about any fatigue? Do you feel like you're more tired than usual?

P: Yeah, these past few days I have definitely. I felt more tired, I've been sleeping a lot more throughout the day and just I don't know, kind of lazy.

D: Yeah, and I know you mentioned you're having a hard time tasting. How about your appetite though? Do you feel like you've lost appetite?

P: I think appetite's been OK. I've been hungry.

D: Yeah, OK umm, how about muscle aches?

P: Umm, no, just tired.

D: OK and chest pain?

P: No chest pain.

D: Alright, do you have a feeling like your heart's racing?

P: No, nothing like that.

D: OK, any changes in your bowel movements?

P: Umm, yeah, well, I had diarrhea this morning actually.

D: OK, so some diarrhea this morning.

P: None before that though. It was just the one or kind of two times, but it hasn't happened since then.

D: OK, no constipation?

P: No.

D: No blood in your stool?

P: I know I didn't see anything red.

D: OK, how about your stool seeming like it's very dark? Almost to the point where it looks black?

P: Oh no, it it wasn't dark like that.

D: OK, good, any abdominal pain?

P: No.

D: Any issues swallowing food?

P: Umm, no issues swallowing food. My throat has felt a bit itchy. I mean I've been coughing alot.

D: Does it feel sore as well?

P: Not really or just kind of yeah, kind of scratchy.

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

P: Umm, not really.

D: No, OK, any rashes?

P: Umm, no. I haven't noticed any rashes.

D: OK, and are things normal with your urine?

P: Yeah they are.

D: How about dizziness or fainting spells?

P: Umm, a little bit dizzy I when I got out of bed this morning, but we sat back down for a couple of minutes. I felt better.

D: OK, good good. Do you think that this morning you were dizzy because you were dehydrated? Or is this like a normal thing for you?

P: I mean, I guess I could have been dehydrated. I didn't even think of that, but I mean, since the food didn't taste so great, I don't know. I probably didn't eat as much yesterday or the last couple of days. Maybe I haven't eaten as much.

D: OK, Yep. OK, do you feel weak?

P: I don't know, maybe. Maybe a little weak, but umm, just way more tired.

D: OK, any confusion or memory loss?

P: Umm, no, I have been able to do some of my school work.

D: OK, good. And you mentioned no rashes, right?

P: No rash.

D: OK, any weight loss over the past couple of months?

P:: Nothing like that. No weight change, it's been the same.

D: OK, how about umm night sweats or chills?

P: I felt a bit, umm, hot but not sweaty, just hot.

D: OK, so kind of like you have a fever?

P: Yeah, I guess so, maybe.

D: Sure any muscle aches?

P: Umm, no muscle aches.

D: Have you been around anyone who's been sick recently?

P: Yeah there is this guy in my class who was sick in class last week.

D: What kind of symptoms did he have?

P: Well, he had a cough and fever. Yeah, I think he had a cough and a fever and somebody said that. Maybe a sore throat or something like that.

D: OK, so yeah, some symptoms overlap with yours I guess. Have you traveled anywhere recently?

P: Oh no, I've been at home. We just started back at going in person to school again.

D: OK, that's good. And are you otherwise healthy?

P: Yeah, I haven't been diagnosed with any medical conditions in the past.

D: Oh good, OK. And do you have any allergies?

P: Possibly cats but we don't have any pets at home.

D: OK, good have you been around cats recently?

P: No.

D: OK and then any hospitalizations or surgeries in the past?

P: I did have my appendix taken out like 4 four years ago. Yeah, at the beginning of high school, but that was the only surgeryand everything went well.

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

P: I am, yeah. I have my immunization card here actually.

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

P: I know my grandfather had lung cancer, but he smoked his whole life also. Also diabetes but don't know if he had any heart problems though.

D: OK, I'm sorry I forgot to ask you, are you on any medications?

P: Umm, I'm not.

D: OK, and do you smoke?

P: Umm, I don't.

D: OK, how about marijuana?

P: Uh, no. Oh, but I guess I use a vape every once in a while..

D: With like marijuana?

P: No, it's like those flavored ones.

D: Oh OK, yeah. How often do you use that?

P: It's like a few times a day.

D: OK, and is there any tobacco in there or nicotine?

P: I think there might be, but umm, I don't know. I usually just buy the flavored ones.

D: OK, well, you should probably look into if it has tobacco or nicotine, because neither of those are good for your health. And so we can, you know, have a discussion later on trying to cut down or quitting completely if you are open to that.

P: Yeah, sure.

D: I'll just continue on asking you some other questions. Do you drink alcohol?

P: Umm, no.

D: And who do you live with?

P: I live with my mom, my step dad, and then my younger sister.

D: OK, do you guys live in a house?

P: We live in a townhouse.

D: OK, in the city you said?

P: Yeah, yeah, I live close. I go to high school not too far from here.

D: Oh, that's nice. And any concerns with the living arrangements in terms of you know, like it being an old building, old carpets, mold, anything like that?

P: No, I live in a nice place. It's usually like really clean.

D: OK, good, umm alright, so those are all the questions I had for you. Did you have any questions or any concerns that you wanted to bring up?

P: I guess the only thing that I was concerned about was possibly having COVID.

D: Yeah, you know, that's probably top on my list of things to investigate you for, so I would say COVID or other viral illnesses that could be going around this time of year. That would have less of a similar presentation, and so we will do a COVID swab for you. And in the meantime, if you could isolate for 14 days, regardless of whether the swab comes back positive or negative, and that would be great. If the swab comes back positive, we will notify public health and they'll try to trace where you could have caught this from and if it turns out it's not a viral illness, we will try to work you up for any bacterial infections which can be treated with antibiotics. So that's where we will start, does that sound good?

P: Yeah, that makes sense.

D: OK great, well have a great day.

P: Yeah, thank you.


D: What brings you in here today?

P: Hey, I'm I'm the mom of, of the patient. He's he's a kid, he has had, he just had a cough and stuffy nose for the past three days.

D: OK, and so did they both start around the same time or one started before the other?

P: They started the same time. He's also had like these, these, his eyes have been like kind of red and watery as well.

D: OK, and is he, what kind of cough is he having a dry cough or wet cough?

P: It's a dry cough.

D: Dry cough, OK and and so with the congestion is he also having any kind of nasal drainage?

P: Yeah, it's it's like watery.

D: Watery OK so now are you noticing any kind of yellow or greenish material?

P: No.

D: OK, and he hasn't, is he coughing up any blood at all at any point?

P: No no no.

D: And so this started just recently three days ago. Was he in contact with anyone that's been sick recently?

P: I don't think so, but he has been like playing outside quite a bit. And sometimes he's just playing with the neighbours kids.

D: OK. Has this happened before?

P: Yeah it has, but I guess what I'm concerned about is the rash that he has now that he's never had before.

D: OK, and where is the rash, exactly?

P: It's on his face. It started this morning.

D: OK, and can you describe the rash for me like it's color, shapes, and what kind of looks like?

P: Small really small dots like kind of, uhm, like I'd say like brown in color. Like brownish dark reddish.

D: OK, let's just are they just located on his face?

P: Yeah, like it was on his face and it's kind of a little bit on his neck.

D: OK, uh and is he scratching at them at all?

P: Yeah.

D: OK, Um, OK and so they just started today. Have you had these rashes before at all?

P: No, no he hasn't.

D: OK, anything new at all that he has either eaten or any new clothing or new laundry detergent or soap, so anything at all?

P: No no.

D: OK. OK, And has he had any fevers or chills anything like that?

P: Uh, he has been feeling a little bit warm. I didn't really check his temperature.

D: And. And busy so, it started three days ago. Anything happened before 3 days at all that might have caused the symptoms?

P: I don't think so. As I said, he has been playing around with others so could have caught something?

D: OK, And OK, any kind of ah, have you tried anything that has helped him at all? Any medications?

P: Uhm? I haven't tried anything yet, no.

D: OK, and how often is he coughing? Is he coughing throughout the day or is it more so with exerting himself?

P: Um, it's just kind of all through the day. It's actually gotten a little bit better. Uhm, the cough has gotten better. But what I'm concerned about is the, the rash?

D: OK cough's gotten better yeah. Does he have visit rush it so is it mainly just on his forehead or also on his cheeks?

P: It's on his cheeks on his chin. It's kind of on his neck. It's kind of like this blotchy reddish, brownish like little dots. Kind of, it's not like, it's not raised, it's like flat.

D: OK, and uh. Is it kind of just a bit like a bright red rash that's kind of covering the cheeks or little little dots everywhere?

P: Kind of little dots.

D: OK, any anything on his nose?

P: Yeah, yeah, it's on his nose as well.

D: OK, um, OK, but no fevers, right?

P: He, I guess he might have had a fever. He was feeling warm.

D: OK. And any other symptoms like shortness of breath, sore throat, anything like that?

P: No, no, nothing like that.

D: OK. And otherwise, any other symptoms like just not like behavioural changes, not being himself, being more irritable at all?

P: So yeah, he's just been tired. He hasn't been doing anything, he's just been lying in bed. Hasn't eaten.

D: OK. Any at all, is he having any nausea or vomiting?

P: No.

D: Any diarrhea or constipation?

P: No.

D: Any changes in his urination?

P: No.

D: Any changes in his sleep or appetite?

P: No. Well, he has been eating little less, but nothing like nothing else.

D: OK. And has he been complaining at all of any abdominal pain or anything like that?

P: No.

D: OK. Otherwise that has he been healthy or if he had any medical conditions diagnosed?

P: He's been healthy.

D: OK. And and any previous surgeries or hospitalizations?

P: No.

D: Any medications that he takes regularly?

P: No.

D: And any family history of any lung or heart conditions?

P: No.

D: Concurrently, or like during your pregnancy with him, any complications at all?

P: No.

D: And did, was he meeting his milestones that developmentally in terms of, also with growth and height and everything like that?

P: Yeah, he seems to be doing OK come when he's doing as well as his other brother, his two brothers.

D: OK, and does he go to school at all? What grade is he in?

P: He's going to school. Um, online.

D: Online right now? OK, yeah. And any issues at school at all. Any complaints that we've been told?

P: No.

D: OK. Great, so, uh and how is the houses or your living situation like?

P: It's, uh, things are good, so it's him, his two older brothers, my husband and me.

D: OK, and has anyone been sick recently or had similar symptoms?

P: No.

D: OK. Alright. Has anyone in the family ever had any diagnosis of asthma, eczema, allergic rhinitis?

P: No.

D: No, nothing like that, OK. Alright, so yeah those are all the questions I had for you today. Do you have any questions or concerns?

P: No.

D: OK. So yeah, so, we'll, we'll be doing a couple we'll do a physical examination, I want to see examined with the rash looks like and there's many things that can cause a rash. There's uh viral infections that can cause some of the symptoms. The symptoms he's having mainly seen viral with a dry cough and runny nose. And then you can we have a rash as well. One thing I forgot to ask actually is is he fully immunized?

P: Um, he I guess he didn't get all his immunizations done earlier. He did get them a little bit later so we came from Syria as refugees. But I I'm thinking he got all his immunizations when he, uh, came to, when we moved to Canada.

D: OK, and is he complaining of joint or muscle aches at all?

P: No.

D: No, nothing like that, OK. Alright, so yeah, we'll do it like a full physical examination, and if it's more just a viral, it'll be something that we'll just have to monitor and do supportive care for. But if it's anything else we might need to do further investigations. OK, and we'll just do a COVID swab for him today as well as some of the symptoms overlap with COVID symptoms and you will get the results back in 24 hours to 48 hours and then further instruction from public health.

P: Sounds great.

D: Alright, well, take care, talk to you soon.


D: What brings you in?

P: I've just been having uh, this pain in my um right, right elbow, and it's just been getting worse over the last few days. I started having it around three days ago. Um, and it's just been getting worse with any kind of gripping motion or, yeah, so it's, it's been getting worse.

D: Okay, so you said it started three days ago. Um, has it been persistent since, or has it been like on and off?

P: It's been pretty persistent, um, but it's mainly when I'm uh, doing some activities or lifting anything. Um, and yes, I've just been trying to rest it mostly.

D: Okay, okay, that's good. And um, you said it's worse with activity and better with rest. Have you tried anything else for it?

P: Um, I've tried some Advil, it, it seemed to help a little bit, but uh, it just comes back.

D: Okay, um, and if you were to describe the quality of this pain, would you say it's sharp, burning, throbbing, achy?

P: It's more um, like if I don't extend my wrist, it's kind of like achy, but then if I extend my wrist, I feel like a sharp pain at um, on the um, just on the outside of my elbow.

D: Okay, alright. Um alright, and then um, in terms of severity, 1 to 10, 10 being the worst pain you've ever felt, how bad is the pain?

P: Um, probably like a 6 or 7.

D: Okay. Alright, um, and have you ever experienced this type of pain before?

P: No, I, I, I've never experienced any kind of pain there at least.

D: Okay. Um, how about um, in terms of like timeline, is it getting worse?

P: Um, just over the past three days, I feel like it's, I have tried not to use it that much. Uh, like when I was at work, I have to use like tools a lot um, and I noticed that when I was using a screwdriver, like it, it hurt a lot. So it hasn't been getting worse, but if I try to do anything at work, it definitely hurts a lot more.

D: Okay, um, alright. And then have you noticed any numbness or tingling?

P: Um, no, no, nothing like that.

D: No, okay. How about um, pain elsewhere on your body?

P: Sorry, what was that?

D: Pain elsewhere on your body?

P: Oh no, no pain elsewhere.

D: Okay, um, and have you noticed any muscle weakness?

P: Uh, no.

D: No. Any headaches?

P: No.

D: Dizziness?

P: No.

D: Uh, weight loss?

P: No.

D: Fevers or chills?

P: No.

D: Rashes?

P: No.

D: Uh, changes in your vision, hearing, smell, or taste?

P: No.

D: Uh, coughing, shortness of breath, or wheezing?

P: No.

D: Chest pain or heart palpitations?

P: No.

D: Uh, changes in your bowel movements?

P: No.

D: Nausea or vomiting?

P: No.

D: Changes in your voiding?

P: No.

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

P: Yeah no, I've been healthy, uh, no other issues in my Life.

D: Okay, that's good. Um, how about, um, medications, are you on any?

P: No, no medications. I've just been taking some Advil for this pain.

D: Okay, I see. And how about immunizations? Are you up-to-date?

P: Yeah.

D: Do you have any allergies?

P: Uh, no.

D: Family history of any musculoskeletal issues?

P: No, just uh, I guess my dad, he's, he's getting some knee pain and hip pain now, starting now. But like that's about it.

D: How old is he?

P: My dad, he's 60.

D: Okay, and any lung or heart conditions?

P: No.

D: Autoimmmune condition?

P: Uh, not that I know of.

D: Okay, and how about cancers?

P: Um, I think my aunt on my mother's side, um, she, she had, uh, uterine cancer.

D: Okay, I see, alright. Um any allergies, or sorry, you answered that. Do you, do you smoke?

P: Uh, no.

D: No. Um, do you consume any marijuana?

P: Uh, no.

D: Do you drink alcohol?

P: Um, just, like maybe some wine on uh, wine, beer every couple days.

D: Okay, um, and where do you live right now? And who do you live with?

P: Um, I live with my wife and uh, four year old daughter.

D: Okay. Um, any concerns for STIs?

P: No.

D: Any sick contacts recently?

P: No.

D: Have you traveled anywhere recently?

P: No.

D: Okay, well um, let's move on to the physical exam part of this interview then. Um, so I'm going to get you to look at both your uh, arms and hands and you let me know if you see any redness or swelling in uh, your right arm compared to your left.

P: Okay. Um, so like, with movement?

D: Uh no, uh, just on inspection, do you see any redness or swelling?

P: Um, no, I don't really see anything that's too different, no.

D: No, okay. Uh, do you see any deformities, atrophy, or skin changes in your right compared to your left arm or hand?

P: No, they look pretty similar to me.

D: Okay. Alright, and then I'm gonna get you to press down on certain areas of your right arm. So you can start with the back of your elbow. Does that hurt?

P: Uh, just like right on the elbow, it doesn't hurt, but when I go on the outside part, it does hurt on the back.

D: Okay, so like the lateral aspect of your elbow?

P: Yeah, it's like sore if I press down.

D: Okay, how about the medial aspect of your elbow?

P: Um, so yeah, on the inside, not so much. Maybe a little bit, not, not that much.

D: Okay, how about when you press down on your biceps or triceps?

P: Uh, nothing.

D: Nothing. How about when you um, press down on your like, forearm extensor muscle group?

P: Um, just, yeah, so just on the outside of my forearm, close to where the elbow pain is, if I go down a little bit and press down, it does definitely feel sore.

D: Okay, and then how about with your forearm uh, flexor, flexors.

P: So on the inside, um, not so much, no.

D: No, okay. And now I'm gonna get you to walk through some movements with me. Um, can you uh, get a piece of paper and, actually can you get a pencil and grip it as tight as you can. Um, do you find that you feel weak when you do that?

P: Um, not weak, but it does definitely like um, when I picked up the pencil and moved my wrist up, it did, it did uh, cause some, some pain.

D: Okay, alright. So would you mind extending or like straightening out your elbow all the way and then also straightening out your wrists. Um, does that hurt?

P: Uh, straightening out, no, it doesn't hurt.

D: Even with uh, like the wrist um, straightened out?

P: Um, yeah if I, if I completely straighten out my wrist uh, then like I just feel a bit of uh, soreness, but not as much pain as when I, um, am lifting something with my wrist or just raising my wrist upwards.

D: Okay. Okay, how about when you flex your wrist all the way?

P: Um, that hurts a little bit, but not nearly as much as when I extend it.

D: Okay. Okay, um, those are all the questions I had for you today, and did you have any questions of your own for myself?

P: Uh, yeah, I was just wondering what this, this might be.

D: Yeah, so um, it sounds like you have something called tennis elbow or lateral epicondylitis. Um, and it's usually related to some overuse, um, injury, so whether at work, or if you play a lot of tennis or some sort of sport, that um, overuses a certain muscle group, um, particularly like the forearm extensors. Um, and so basically for this, um, we suggest a few things. We'll start with like some conservative management, like activity modification. So at work, if you're doing repetitive movements, maybe not do them so much and take frequent breaks, you can try some like ibuprofen, we'll refer you to some um, physiotherapy to help build those muscles around that, that area. And if those still do, don't work, um, we can try some um, other things like operative um, operative management, but we'll, we'll come back to that in about 6 to 12 months, um, once we uh, we try all of the other stuff. Does that sound okay?

P: Yeah, that sounds good. Thank you.

D: Yeah, no worries.


D: Do you want to tell me what brought you in today?

P: Yeah, so for the past two days I I've I've noticed that I can't smell things as well, as I used to be able to smell them and I seem to have lost my sense of taste as well. And I have this mild dry cough. I'm just worried it's covid.

D: OK. You said for a couple days?

P: Yes, for two days.

D: OK, have you ever had anything like this before?

P: No, no, nothing like this.

D: OK, when you say you feel like you've lost sense of taste and smell, is it totally gone or do you taste a little bit? Or how? How is that working for you?

P: The smell isn't totally gone I can still smell something if it smells really really bad and and then and then I can taste really, really salty foods, but I can taste normal things like I can't taste of banana.

D: OK, is that been pretty consistent throughout the last couple of days or is it on and off?

P: It's been pretty consistent, yeah.

D: OK. And did this dry cough that start at the same time?

P: Yes.

D: And when you say sorry, you said mild cough, and I my next question was do you feel like it's a dry cough or you producing any sputum? Any blood? Or is it to not, not bringing up anything?

P: It's dry.

D: OK, has that gotten worse over the last couple of days?

P: The dry cough? Um it's been pretty consistent as well.

D: OK is there, have you done anything to try to make it better? Have you taken any over the counter medications or?

P: No, I haven't tried anything.

D: OK, OK. Have you had, in addition to these symptoms, have you had any fevers?

P: Fevers, no fevers.

D: OK, any difficulty breathing?

P: No.

D: OK, any headaches?

P: Um no, no headaches.

D: OK, any sore throat?

P: No.

D: OK, any chills or night sweats?

P: No.

D: OK, any muscle ache or general weakness?

P: Uh no.

D: OK, so generally it seems like you're pretty well other than this loss of taste slash smell and the dry cough that correct,

P: Yes.

D: OK and then recently have you been in contact with anyone that's been sick?

P: Um no not that I can remember or yeah, not that I can remember.

D: OK, have you traveled anywhere?

P: Um I went hiking with my partner two weeks ago. I guess there were some people who kind of brushed by us, but other than that I don't see where else I could have gotten this from.

D: OK, was that hiking somewhere close by?

P: Yeah, it was like half an hour from where we are.

D: OK. Are your immunizations up to date?

P: Yes.

D: OK, and can you think of any for this dry cough, just a circle back to that. Can you think of anything that triggers it? It's called the cold or being around certain things like cats or dogs or any other environmental things?

P: No.

D: OK. Have you had any chest pain? Thats the other thing . I'm not sure if I asked you .

P: No no chest pain.

D: OK. And in terms of your general health, do you? Do you have any chronic conditions that you live with?

P: Um no no.

D: Do you take any medications?

P: No.

D: OK, have you ever had any surgery or been hospitalized for another reason?

P: Um no.

D: Do you have any allergies?

P: No allergies.

D: Do you have any family history of respiratory problems, cancers or heart problems?

P: No, nothing like that.

D: OK. And just in terms of free lifestyle, so do you live with family?

P: Um no.

D: OK, do you read along with a partner or roommate?

P: I live with my parents and my younger sibling.

D: OK. And is that in town here?

P: Yes, yeah.

D: OK. And in general, do you eat a healthy diet? Do you exercise?

P: Yeah, I think so.

D: Do you smoke?

P: Uh no.

D: OK, do you drink alcohol?

P: Uh I I have drank alcohol before but not not regularly.

D: OK um. And I do use marijuana?

P: Um I have taken edibles before but also not very regularly.

D: OK, any other drugs?

P: No.

D: OK, and are you currently in high school?

P: Uh yes, I am in my last year of high school.

D: OK, and how is that going?

P: Pretty good, yeah, we're doing things online now.

D: So you haven't really been out of the house?

P: No.

D: OK. OK. Uhm I think that's all my questions for now. Uh I definitely like to get you a covid test just because your symptoms are consistent with some common covid symptoms. So basically that means that we would do a swab. It might not come back for a day or two. You definitely have to self isolate between now and when you get the results back, potentially even if it's negative, longer, if you're still having symptoms.

P: Yeah.

D: Otherwise, there probably. There might be a couple other tests we want to do. We might have more questions when we come back, we'll go over this with the doctor that I'm working with today, but just wanted to give you a heads up of what to expect next. Did you have anything else you wanted to tell me that I didn't ask you about or any questions?

P: No, uh thank you so much.

D: OK, well thanks for coming in today. Will definitely get you taken care of shortly.

P: Thank you.

D: K thanks.


D: Could you start with telling me what brought you in today?

P: Hi, I've just been been so like weak and so tired, I just I can't I can't seem to like get off the couch, like I'll get up from my bed and go lay on the couch and then you know I might be able to get something to eat but I just I get so tired so fast and I don't know I don't know what's wrong.

D: OK, when did these symptoms start?

P: Um, like I've been feeling pretty tired for like a week, but like this bad for like maybe four days.

D: OK, um and so it sounds like you haven't been going to work or like anything like that because you have been so kind of tired and weak.

P: Yeah, I mean at first I was already kind of working. I'm I'm a truck driver so you know, once you start the job, you kind of have to finish that. I was supposed to go on another another trip like 4 days ago and I just couldn't. I had to call my boss and say that I can't.

D: OK, um have you had any like specific muscle weakness like in your legs or or in your arms? Or would you say it's overall like a general weakness?

P: It's just everywhere. It's it's not like I can't move. I'm just really, really tired.

D: OK, and how, how have you been sleeping?

P: I mean, I've just been sleeping like all the time. I have been sleeping all night and then like I said, I get up and I go to the couch and like just fall back asleep.

D: OK, uh, have you been having any other symptoms?

P: I mean my my throat is maybe a little sore, but nothing nothing else.

D: OK, uh, when when did the sore throat first start?

P: Probably probably about a week ago. It's not really bad, it's just kinda there.

D: OK, so it's it started just before uh, the weakness and fatigue?

P: Yeah, around the same time.

D: OK, um, and have you been having any pain with swallowing?

P: Uh, I mean maybe a little bit.

D: OK, like with uh, like solid foods or liquids or both?

P: It it's just like it's just like it's a little a little tender. It's not like, really it's not like hard to swallow or anything, it just feels like it's like my throat's kinda tired.

D: OK, have you had any changes to your voice?

P: Uh, no, I don't think so. I mean, I live. I live alone so I can't really ask someone else if I have.

D: OK, but your voice sounds the same to you?

P: Yeah, I think so.

D: Alright, um, and so have you been having any fevers or chills?

P: Um, I've been, I've been feeling really cold.

D: OK, have you had any, uh, like shakes or or rigors?

P: I've been like kind of kind of shivering.

D: OK, how about any night sweats?

P: Um, yeah, come to think of it, like I was I was, when I was last traveling with, when I was last on it because I'm a truck driver, I I was in the States, I I had to bring something to Ohio, and I had to change my clothes in the night. They were just like so drenched in sweat.

D: OK, has that happened more than that that one time?

P: Maybe a couple times that it wasn't as bad, that one time was really bad, but here and there like I I've been feeling pretty sweaty at night in general.

D: OK, and have you had any, uh, like difficulties breathing or shortness of breath?

P: Not really, just like kind of tired, but it's not like hard to breathe.

D: OK, um have you had a cough?

P: Uh, no.

D: OK, how about a runny nose?

P: Maybe maybe a little bit, but not like too noticeable.

D: OK, and when did the runny nose start?

P: Oh, it's all like around the same time.

D: OK and have you been having any headaches?

P: A little.

D: OK, and then how about any chest pain?

P: No no. No chest pain.

D: Alright, and how about any wheezing?

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

D: Alright, then any heart palpitations?

P: No.

D: OK, have you felt lightheaded or or like you were going to pass out or faint?

P: Uh not like I've been feeling really tired, but it's not been like I don't think it's been like fainting.

D: OK, so kind of like you are fatigued that you've been experiencing. Um, have you had any abdominal pain?

P: I mean, I'm not really eating a lot, so it's kind of like gurgling.

D: OK, have you had any nausea or vomiting?

P: Uh, no.

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

P: No.

D: Any bowel problems?

P: No, I mean, you know I haven't been eating that much, so I haven't been going as much as normal, but it's I don't think there's problems.

D: OK, so you haven't had any diarrhea?

P: No.

D: OK. Um, and have you had any skin rashes?

P: No, not that I've noticed.

D: OK, and um have you had any like muscle aches or or joint aches?

P: I mean, I feel kind of achy all over but not in like one particular spot.

D: OK. And in terms of your past health, have you been, is there any reason you you see a doctor regularly?

P: Oh Oh yeah, like I have I have high blood pressure and diabetes. Yeah, that's that's pretty well it, but yeah, those two things. Oh and I take a medication for my prostate.

D: Oh OK, um, and do you take medications for the blood pressure and diabetes?

P: I yeah yeah, I um, oh geez, what's it called? I take ramipril, and I take Metformin. I was on insulin but I pretty well I just have been able to eat well so I'm not taking it now. And then, uh, I can't remember the, uh, the prostate one. Like tam, tam something.

D: OK, maybe tamsulosin?

P: That sounds right, yeah.

D: OK, I can check on the chart as well to confirm. Um, do you have any allergies to medications?

P: No.

D: Alright, and any recent hospitalizations?

P: No, no, I've been pretty good.

D: OK, and any surgeries?

P: Uh, not for a really long time, I I had my gallbladder out like 20 years ago. Yeah, that's it.

D: OK, um, and has anything like this happened to you or any of your family members before, suddenly they start started to feel fatigue like this?

P: I don't think so. I mean, we've all like you know, caught colds and you know stuff like bugs and stuff but, not not quite like this, like I can barely get up.

D: OK, anybody in the family have a history of heart disease or cardiovascular disease?

P: My dad had high blood pressure, that's it.

D: OK, anybody in the family have cancer?

P: My mom, my mom had breast cancer.

D: OK, and you told me that that you work as a trucker, so you were over in the states, it sounds like. How recently were you in the United States?

P: That was like about a week ago. I probably got back five or six days ago.

D: OK, do you travel there often?

P: Oh yeah, yeah. I mean that's you know the route that I usually take.

D: OK, uh any anybody you interacted with that was sick, do you believe?

P: I don't. I don't really interact with with many people. I kind of just go there and um, and then you know I stayed in a hotel. But you know, I didn't really see anyone besides like the lady that works there. And maybe you know, the people at the McDonald's like counter. I didn't I didn't like see anyone that I know that I sat with for a long time or anything.

D: OK, but you got home about five or six days ago. Um, yeah, and who are you living with currently?

P: Just me.

D: OK, and do you drink alcohol?

P: Oh no. No, I used to a little bit, but not not anymore.

D: OK, and how about cigarettes? Do you smoke cigarettes?

P: I quit um 10 years ago.

D: OK.

P: I smoked I smoked probably like 1/2 a pack a day for for a while, maybe 20 years.

D: OK, but you quit over 10 years ago?

P: Uh, about 10 years ago, yeah.

D: OK, and do you smoke marijuana?

P: No no.

D: Alright, and how about any other recreational drug use, including the use of IV drugs?

P: No, nothing like that.

D: OK, and are you currently sexually active?

P: No no.

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

P: No no.

D: OK uh, and are you currently in a in a relationship?

P: Uh, no, uh, like I have I have a friend that I see and we both, um, we both lost our spouses, um, several years ago, and I
mean, we, we see each other and like we live in the same apartment building and often have meals together. But we're just like friends.

D: OK.

P: But that's the person that would check on me if I needed it.

D: OK, that's great. It sounds like you have some good support nearby. I'm sorry to hear about your wife. But I think that was all of the questions that I wanted to ask on the the history today. So next I we're gonna order some some lab work for sure to start with then and maybe we'll go from there. So we'll give you some fluids, and maybe some Tylenol and we will see what the lab work shows.

P: OK, thank you.

D: Oh, you're welcome.


D: What brings you in here today?

P: I've been having this pain in my knee and it's been going on now for a few weeks. It's kind of right at the, I could feel it right below my kneecap and at first it it was really only bothering me after activity, but now it's starting to hurt during as well, and so it's, it's trying to limit my ability to play basketball.

D: OK, and so you said this started just two weeks ago?

P: Yeah, about about a few yeah few weeks ago.

D: OK, and has the pain so it's been getting a bit worse and with activity and it's right below your kneecap, is it the right way or the left leg?

P: Yeah, it's on the right side. It's my right right side. Yeah.

D: OK. And what kind of pain are you experiencing, is it kind of a sharp pain or is it a dull aching pain?

P: It's, uh, it's pretty achy.

D: Yeah, it take you. OK, and does the pain travel anywhere else or does it, it's just right below your kneecap?

P: It's right below my kneecap, yeah I feel like it's just over a kind of a small area it's a pretty specific spot and if I press on that area at all it gives me a pretty, it's a sharp pain if I if I press on it sharp pain.

D: OK. And on a scale of zero to 1010 being the worst pain you felt in your life, how much would you rank the rate this pain?

P: I it's about about a six or seven.

D: Six or seven OK. And is it a constant pain, or like do you get the pain when you're not playing basketball or doing other activities?

P: Um I'll get it if I'm. Like sometimes I'll feel it if I'm going upstairs like walking upstairs or. Like if I'm sitting for a long, long time and I I get up, it'll feel a bit sore. But it's mostly if I'm like doing activities like running or jumping, doing like strenuous stuff like that.

D: OK I see, an has this ever happened before?

P: No, I haven't had any any issues with my knee before.

D: OK. And otherwise, are you having any other symptoms besides the pain, like any numbness, tingling?

P: No, nothing like that. It's just the pain.

D: OK, and any weakness in your legs?

P: Um no, no weakness.

D: OK, and uh. Have you tried anything that improves the pain at all or anything that makes it worse?

P: Um I I have tried taking some like Tylenol and Advil and that or or and NSAIDs that and it has helped with the pain. I've tried icing it too, like after practice and stuff like that which does seem to help a little bit, but uh. Yeah, that's about it.

D: OK. OK, and other than that, did you like have a fall or did you have any injuries recently before you started having this pain?

P: No, it's kind of come on on its own, no falls or like trauma to the knee.

D: OK. And other than that, are you healthy, do you have any medical conditions at all?

P: Um, yeah, I don't have anything I am healthy.

D: OK, any medications that you take on a regular basis?

P: No, not not. Nothing. I don't take anything.

D: OK. Any allergies?

P: No allergies.

D: OK, and have you been sick recently at all with fevers, chills, any cold or viral symptoms?

P: No, I haven't had anything like that. I've been feeling well.

D: OK, uhm. Any changes in your skin, like any rashes?

P: No, I haven't had any any rashes.

D: OK, and any kind of shortness of breath, chest pain?

P: Nope, nothing like that.

D: OK. And any changes in your bowel movements or urinary patterns?

P: No, I haven't had any changes there.

D: OK, OK. And do you have any recent or like past history of any hospitalizations or surgeries?

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

D: OK, and any family history of any musculoskeletal conditions or any anything that runs in the family?

P: No, not nothing like that, no.

D: OK, OK. And currently right now. Do you do you go to school or do you work at all?

P: Yeah, I go to school. And, uh, I play on the, uh soccer team and the basketball team. It's basketball season right now. And, uh, in grade 10.

D: OK in grade 10 OK. And school going well, any issues at all with bullying or anything like that?

P: No school's been been going well. I have been doing well in my courses and have a good group of friends so I enjoy it. It's fun.

D: OK. And what's your home situation like, do you, who do you live with?

P: So I live with both of my parents and I have a a younger sister as well. She's in grade grade 7 and we have a dog as well.

D: OK, and do you generally feel safe at home as well as outside of your home environment?

P: I do, yeah my I get along well with my parents and we. Yeah, but my parents are great.

D: That's good and and this is just wanted to let you know that anything that you talk about in here with us stays confidential and won't leave this room unless there is potential harm to yourself or others. So have you tried any recreational drugs like marijuana, have you tried smoking or alcohol at all?

P: No, I've been trying. I stay away from that, that sort of thing. I've I know about other people in my class who have and stuff, but I always just, I'm just trying to stay as ready as I can for the sports.

D: OK, that's good. And yeah, so and are you up to date with all your immunizations?

P: Yeah yeah, my mom made sure that I got all of that stuff done.

D: OK. Alright, so yeah, those are some questions I had. I just have a few more questions with regards to just examining your knee. Are you able to walk or do you have any kind of a limp?

P: No limp I can. I can walk OK.

D: OK and are you able to run?

P: Yeah I can. I can run, but when I do it it causes some pain. I'm able to still run but yeah it it hurts.

D: OK and. So when you palpate your lower knee just under the patella, you said it's a sharp pain, right?

P: Yeah exactly and then when I it's, and it feels kind of achey or when when, like after practice or something like that, but if you press on it it it's sharp.

D: And, uh. Any any kind of like are you able to flex and extend your knee right now if you tried?

P: I can yeah.

D:  OK and have you noticed any kind of rotation of your knee at all?

P: No, nothing like that.

D: No OK. OK, and no weakness below your knee, right?

P: No weakness. I just feel like my muscles are really tight like my fly and my hamstring muscles. Think I need to stretch them out some more, they do just feel tight.

D: OK, and do you notice any kind of swelling or redness or bruising in the area?

P: No.

D:  no OK, and your ankle and hips you don't have any pain or issues with movement, right?

P: No, not at all. No, no problems with my ankle or hip.

D: OK alright yeah. So those are just all the questions I had for you today. Do you have any questions?

P: I was just wondering what I can do to make this go away.

D: Yeah, so definitely this is something that is what we call Jumpers knee. It's fairly common, uh, amongst younger athletes, especially those that play sports like volleyball or basketball. But right now we don't really need to do any kind of imaging or anything like that. It seems like you're in the earlier phases and it's good that you came in. We definitely do need to manage it with some conservative management where we're going to keep having taking a look at it as well as I would recommend icing it every, like for half an hour, like around four to six times a day, especially after you're doing your activities. Then you can you can take the, continue taking the Tylenol and Advil, as well. As long as you're following the maximum amount per day depending on if you're taking extra strength Tylenol for example versus the regular strength. And then I will also refer you to some physiotherapy that will kind of a teach you some strengthening and stretching exercises that you can do to help what we call like that you will you might be having is just um some inflammation in your patellar tendon, right below your patella. So we need to strengthen the muscles around it. So we'll do some referral to physiotherapy and then we'll see how you you do based on all those treatment options and then if it gets worse and if or if it doesn't get better, we might need to do some imaging, either ultrasound or an MRI and then see where to go from there. But for now does that sound OK with you?

P: It does, yeah, thank you. So you said that you think it's like a patellar tendonitis or something like that?

D: Yeah, it's patellar tendonitis is commonly called the jumpers knee and it should resolve with the steps that we, especially since it seems like you're in the earlier stages. So it seems like it should be pretty responsive, but if it isn't, there are other steps we can discuss in the future.

P: OK, that sounds great. Thank you.


D: I hear that you have been having some coughing so I'm just going to chat with you for a bit get an idea of how things are going well, have a listen to your lungs in your heart and then I will go grab the doctor that's working today and we'll talk about it and then we'll come back and let you know what the next steps are going to be. That does that sound good to you?

P: Yeah, that sounds great. Thank you.

D: Can you tell me about what brought you in today?

P: Yeah, I've had this cough for the past four or five days and it doesn't seem to be going away or getting better, so I thought I should get it checked out.

D: OK, are you here with your mom today?

P: I am.

D: Hi mum. Um OK. You got a cough you said I'm sorry, you said for five days?

P: For, yeah, four to five days ish, yeah?

D: OK. And, uh, has it you said it was a dry cough? Is that right?

P: Yeah, that's right.

D: OK, so at no point were you bringing up on gunk with your cough?

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

D: OK. Since it started, do you think it's gotten worse or has it kind of stayed the same? Gotten any better?

P: It's kind of stayed the same.

D: OK. OK, uhm. Along with the cough have have you been having any other new symptoms?

P: Uh no.

D: OK, have you had a sore throat?

P: No.

D: Do you feel like you can taste and smell things normally?

P: Yeah, I think so.

D: OK. OK, have you been having a runny nose?

P: Oh yes, I have had that for the past couple of days as well.

D: And is it a runny nose with kind of clear stuff? Is it watery or is it thick? Does it have a color to it a yucky the color?

P: It's pretty clear.

D: OK, OK. Uhm. And uh have you had any fevers? Your mom might be able to answer that one better.

P: Yeah, um. He has had uh like he's had fevers in the past, but I I didn't really check this time. He didn't seem hot. He didn't have any chills.

D: OK, well that's good. Uhm. OK, have you had any back or muscle pain?

P: No.

D: OK. Have you had any chest pain?

P: Uh no, no chest pain.

D: OK. Any, any nausea or vomiting?

P: Uh no, no nausea or vomiting.

D: Have you ever had any pain in your belly?

P: No, nope that no pain in my belly.

D: Any headaches?

P: No, no headaches.

D: OK, have you been around anyone that's been sick?

P: No, not that not that I can remember.

D: OK. Uhm, have you traveled anywhere recently?

P: Uh nope.

D: Are you going to school right now or staying home?

P: I’m going to school and they're doing these half days.

D: OK. OK uhm, and has anyone in your school been sick?

P: Ah, Nope, not recently.

D: At least not that we know of. OK.

P: No.

D: OK, have you ever had anything like this before?

P: No. I've been pretty healthy otherwise. I've never had like I've never had like a dry cough like this. I've had runny nose in the past, but they never lasted this long.

D: OK, have you ever been in the hospital?

P: No.

D: OK. Did you see your family doctor for anything? Any health problems?

P: No, no.

D: Do you take any medicines?

P: No.

D: OK. This may be a tricky one to answer, so Mom can definitely help us. Do you have any family history of respiratory problems?

P: Um uh his grandparents had um asthma, but he's been worked up for that and he doesn't get short of breath or wheezing or anything like that with even with physical activity. So yeah, so he doesn't have that.

D: And what else?

P: Pardon me.

D: I said just some some asthma in the family.

P: Yeah.

D: OK. And so you live, you live with your mom. Do you live with anyone else in your family?

P: I have a four year old sister.

D: OK, do you live with your dad too?

P: Yes.

D: Do you guys have any pets?

P: Um no, no pets.

D: And does anyone smoke in the home?

P: Nope, no.

D: OK, and what do you like to do for fun?

P: Um I like playing with my friends, I like playing video games.

D: Oh cool. So what's your favorite game?

P: I am playing Rollercoaster Tycoon.

D: Oh cool, that sounds like fun. OK well, hopefully we can get you back to feeling healthy so you can continue to play lots of roller coaster Tycoon. So I’m going to go get the doctor that I'm working with. I'm, uh, I'm wondering, you know, he might want to do a chest X Ray and get a better look at what's going on there. Have you ever had an X Ray before?

P: I don't think so, no.

D: Do you know what an X Ray is?

P: A little bit, yeah.

D: Yeah it's like taking picture of your body on the inside. It's pretty cool so it gives us an idea of what's going on in the inside. Also, this really this part is kind of not so much fun, but I think we should probably do a covid swab because we're doing that with anyone that comes in with these symptoms lately and that's not a lot of fun. We gotta stick something up your nose, but I think that you're really brave and I think that you'll be just fine with it, OK?

P: OK.

D: So we're going to arrange for these things and then I will come back with the doctor that I'm working with and we'll kind of talk about where to go from here.

P: OK, that sounds good.

D: Thank you guys for chatting with me.

P: Yeah, thank you.

D: Thanks.


D: How may I help you today?

P: I'm just bringing my son today because he's been how many episodes where I'm eat hell gets all this coughing fit and become wheezy and become shorter breath and I mean after a period of time it goes away, but it's been happening every so often.

D: Does he still have these symptoms?

P: Like right now he's OK. When the symptoms come on, they last for I don't know, maybe 30 minutes, 60 minutes or or even less. But yeah it happens maybe once or twice a week where and it's been going on for a, a couple of months now. Yeah, he actually had a viral infection like a few months ago and I thought it was just that. It leared up and then he's just had a few more of these episodes, but without those kind of symptoms so.

D: Hm? So all this started a couple months ago.

P: Yeah.

D: Do you find that there and you mentioned that it happens about one to two times a week? Is there anything specific happening at that time? Any triggers that result in these symptoms?

P: Well I will say I think I like exercise. I find yeah like soccer practice. Yeah, after maybe, or even during a game, like when things are really intense. Yeah, I think during soccer I've I've kind of noticed it. And then at night time as well. It kind of randomly, he'll have this cough.

D: OK. So I guess it's do you feel like it's affected by cold weather as well or no?

P: Um, maybe yeah, like if he yeah completely in the winter time. Like I know when he goes outside if he yeah he takes like a deep breath or something like that. He'll talk about having shortness of breath or difficulty breathing in the cold weather.

D: OK, other than the and I guess the cough. Is he coughing up anything, or is it kind of a dry cough?

P: It's dry.

D: OK. Does he have any like chest pain during these episodes.

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

D: Alright, any fevers?

P: No, he had a little bit of a fever at the that one time a few months ago, but he hasn't. So that's right. I think he had a some sort of illness then, but he hasn't had any fevers.

D: I see. OK, any headaches?

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

D: OK. And how has he had any other symptoms so anything like racing heart or belly pain or muscle aches or any changes in his bowel movements or urinary symptoms?

P: Uh no, I haven't heard him, uh, I complain about anything like that. I think I'll everything like that's been normal.

D: OK. So when he has these episodes, how like how severe are they? So how difficult is it for him to breathe?

P: Ah, well, you certainly when it first starts, I mean for the first minute or two. Yeah, he that when I think particularly at soccer practice school have a really hard time catching his breath, but like he would, he stops playing and rests and really tries to make sure that he is I don't know, just trying to to breathe and it kind of goes away. He's been able to manage it OK.

D: OK, alright and I have these symptoms that have interfered with his daily activities? Does he for instance, try to avoid soccer practice. Or does he have difficulties falling asleep at night?

P: Yeah, definitely wakes him up a few and every once in awhile at night and he does have to take it a little easier at soccer for sure. So yeah, I am thinking it is affecting him.

D: OK. And otherwise has he been, has he had any medical conditions that he's been diagnosed with?

P: Uh, no, well he had some rashes when he was younger that he would get some some creams for, but that's mostly resolved now.

D: OK, any hospitalizations or surgeries?

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

D: OK, uhm. And just going back to his birth and your pregnancy, were there any complications at the time of pregnancy?

P: Um, there was a prolonged labor, I think, but he was delivered vaginally and at term

D: OK. OK, that's great.

P: And he, oh sorry, I was just going to say normal weight as well.

D: OK good has, was he kept in the in ICU for a couple of days after, was he sent home?

P: I think they, like he was kept for not an ICU he was kept for one day I think so just monitor for infection because it was like prolonged labor but he was OK. OK, so yeah we were able to go home.

D: OK, and I, what was I going to say. Forgot what I was going to say. How yeah, how has this growth and development been? Has he been seeing his doctor regularly? Any concerns there?

P: Yeah he's been good with with growth. No concerns for that and his developments been normal as well. He's reached all of his milestones.

D: OK, and is he going to school?

P: Yeah, yeah, he's been going to school. He hasn't really been, he hasn't missed well he's missed one or two days actually, because of the cough, like on nights that he just didn't sleep well, so in the morning he's just well, not not feeling good for school so he has missed a couple of days over the last few months.

D: Okay. And does he, is there any other any conditions that run in the family? Including things like asthma or eczema, or allergic rhinitis or allergies.

P: Yeah, sister does have some bad allergies. Her nose runs all the time and she also has that asthma. His sister uses and a daily inhaler and then also W1.

D: I see. OK, and uh. How are things at home is he, is he doing well otherwise? Like at school and things like that, any stressors in his life?

P: No, he's been doing, uh, he's been doing well at school. He likes math and that that's been going, well.

D: OK, great. Has he ever tried any puffers?

P: No, he hasn't actually.

D: Has he been on any medications?

P: Um, he he has not.

D: Any allergies that he has?

P: Not that I'm aware of, but I I think he might. I mean so like environmental or I don't know, something. He does get symptoms like a runny nose and itchy eyes sometimes, but usually go away pretty pretty quickly and he doesn't fuss about it too much so, yeah so.

D: From the symptoms that you've described so far, it sounds like he might also have asthma, but we will obviously have to do some testing and confirm that. Uhm, and also, it's given sort of the results, or even just like giving his symptoms, prescribe some buffers to help with those symptoms. Clearly it's affecting his life. He can't go to school or can't participate in soccer, or sometimes wakes up in the middle of the night, and that's not good. So, we'll we can be prescribed some puffers and see if those help and also get some testing done. Do you have any other questions for me?

P: Uhm, No, yeah I was just wondering about, so like the wheezing and all of that could be with from asthma too?

D: Uhm, yeah, I would think so, but again, we'll get the testing done and see if there are any other, any other causes.

P: Ok.

D: You said the wheezing sort of lasts only 30 to 30 minutes to an hour and then gets better?

P: Yeah, I don't notice that any other times.

D: Yes, it's possibly, I mean, I would think it's asthma, but then we'll get the testing done and see.

P: OK, great, thank you.


D: What brings you here today?

P: Hi, I've been having this back pain for the past month, so I'd just like something for it an and you know image it if possible just to figure out what it is.

D: You've been having it for the last month, is this the first time you're having this back pain?

P: Yeah yes.

D: OK and where exactly are you having the back pain?

P: It's in my lower back.

D: OK, and what kind of pain are you experiencing, is it like a sharp stabbing pain or is that a dull aching pain?

P: It's kind of dull and achy but sometimes I feel like I have little spasms in my back.

D: OK, and how often are you getting these spasms?

P: Um I'd say like two to three times a week.

D: OK. And it is this back pain constant, or does it come come and go?

P: It's pretty constant, but it gets worse with certain things.

D: So one month ago when it started before then, did you injure yourself at all or, were you doing anything that brought on the pain or did the pain come on gradually?

P: So I work in this factory where I move a lot of boxes and I think I may have like lifted a really heavy box or lifted it in an improper position because that's when, that night is when my back started hurting.

D: OK, I see and how long have you worked in this role?

P: For the past 30 years.

D: OK Alright. And has the pain become worse at all or has it stayed the same since it started?

P: I'd say it's pretty. It's been pretty similar to the start.

D: OK. And does the back pain move anywhere, like for example does it shoot down your legs at all?

P: No OK. Have you tried anything that has helped you?

P: I've tried some topical analgesics, and you know those fire and ice gels and I think sometimes that helps, but it's always temporary.

D: OK. And what kind of things make your pain worse like, bending down as opposed to stretching backwards?

P: Yeah, bending down like it when I flex my back that hurts more than if I straighten it out.

D: OK. Is a bending hurts more and what about bending towards the sides?

P: Um a little bit more towards my right side.

D: OK. And are you having any other symptoms, like numbness or tingling in your extremities or back at all?

P: No.

D: And any kind of numbness or loss of sensation in your buttocks area or just below your lower back?

P: Um no

D: OK. And any fevers or chills?

P: Nope.

D: Any night sweats?

P: No.

D: Any um skin changes or rashes?

P: No.

D: Any, have you been ill recently at all with cough cold symptoms at all?

P: No.

D: Do you feel pain in anywhere else, in any other muscles or joints at all?

P: Um no.

D: Have you recently had any changes to your weight?

P: No.

D: OK. And. Any kind of changes to your bowel movements?

P: No.

D: OK. Any kind of issues with urination at all?

P: No.

D: And any urinary or fecal retention or incontinence?

P: No.

D: Right, so it's just this pain that's been there for the last month, stayed around the same. In terms of your medical history have you been diagnosed with the. Have any medical conditions in the past?

P: I have a high blood pressure which I take some Ramipril for.

D: OK. Any allergies to any medications?

P: No.

D: OK and have you are using any other medications at all?

P: No.

D: Have you been hospitalized or had any surgeries in the past?

P: No.

D: OK. Do you have any family history of any musculoskeletal or rheumatologic condition?

P: No.

D: Any cancers in the family?

P: No.

D: And so currently are you working or did you have to take time off work?

P: I'm taking some time off work until I figure out what this back pain is.

D: OK. And currently, what's your living situation like?

P: I live in an apartment with my wife and our teenage son.

D: OK. And do you smoke at all?

P: I used to smoke. I haven't smoked in over 10 years.

D: OK. And do you drink alcohol at all?

P: I drink occasionally, I'll have like a beer on the weekend.

D: Any recreational drugs like marijuana?

P: No.

D: OK. Alright, so I'm just gonna ask a few questions, maybe get you to do some movements and see what hurts the most.

P: OK.

D: So when you press your hand down, down your spine. Is it hurt at all in the lower back with palpation?

P: Um it kinda hurts right in the middle, uh, just above the buttocks area an where like my tailbone almost is

D: I see. And, uh, any kind of pain with lying down and then raising your legs straight up without bending the knees.

P: I can try that. Um that hurts a little bit, yeah.

D: And does it hurt in the lower back or near the front of your hips?

P: That hurts in my lower back.

D: And any kind of redness or swelling that you've noticed at all? I know it's in the back, so it might be more difficult to see.

P: Um no, I don't see anything like that.

D: OK. And are you, has your gait, changed at all, or is it, are you able to walk without a limp or anything?

P: I'm able to walk without a limp.

D: OK. Alright, so and then, uh, bending down you said hurts more than standing up or extending your back, right?

P: Yes.

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

P: No, just like how can I treat this?

D: Yeah, for sure. So this has been going on for the last month. It sounds more like what's called mechanical back pain and due to the nature of your work having been lifting heavy objects for the last 30 or so years it's usually something that occurs with repetitive, repetitive work, and strenuous work like that that affects your back. And what you're describing with the flexion seems more pain coming from the discs themselves instead of the facets at the back. So every time you flex you have some compression of your discs. So what we what we need to do right now is it's been one month almost and then usually we get imaging if the pain does not improve after six weeks of conservative management. So what we can try is to give you some pain management first, and some anti-inflammatory medication, and then as well as try some physiotherapy, some exercises to help you with the back pain. And then if the pain does not improve and since there is no red flags that were too worried about right now with your back pain we can wait to get some imaging. But first we would just like to try some of the conservative management. Is that OK with you?

P: Yeah, that sounds great. Thank you.

D: You're welcome, alright take care.


D: I was wondering if we could start with you telling us what brought you in?

P: Sure, I've had this terrible headache for the past four days. Doesn't seem to be getting any better, and I feel hot like I have a fever. I've been coughing a lot so I am I'm worried I have COVID, so I'm here.

D: OK. So I'll start with the headaches. When did when did that exactly started?

P: Uh the headache started, OK so the coughing started four days ago. The headache started shortly after so I would say later on during that day and then the fever I've had for, fever I think I've had for the past two days. I haven't actually taken my temperature though.

D: OK um. So, uh, the cough is started four days ago. Has the cough gotten better, worse, or stayed the same?

P: The cough has stayed the same.

D: OK, are you bringing up any phlegm or sputum with the cough?

P: Um, it's not really phlegm, but sometimes I cough up, like bits of like. You know little bits that look like blood or something.

D: OK, so you're seeing some like red when when you're coughing up?

P: Mmmm

D: OK, and how much of this are you seeing like, is it like a teaspoon amount or or more?

P: Oh, it's it's very little. It's like maybe a little bit bigger than like the tip of a pencil.

D: Oh OK, are you, OK, are you seeing this on like kind of tissues afterwards sort of thing?

P: Yeah.

D: OK, um and any triggers for the cough you can think of?

P: No, it just seems to be there all day. Um, doesn't really get better with me trying to rest or not.

D: OK, and is the cough there at night time too?

P: Yes, it is definitely there at night.

D: OK, um is it interfering with sleep?

P: Ah yes, I haven't been sleeping well.

D: OK, um, and with your cough have you had any difficulties with breathing?

P: Um, no.

D: Alright, and now, how about any wheezing?

P: No wheezing.

D: OK. And with this headache when it first came on, did you experience a like worst headache of your life, or a Thunder clap sensation?

P: No, it's it's not that bad, but it just seems to be there all day long.

D: OK, um have you had headaches like this before?

P: No, I've never gotten headaches in the past.

D: OK, uh is the headache associated with any nausea or vomiting?

P: No.

D: OK, and is the headache worse in the morning when you first wake up?

P: No.

D: OK, and does it have to get worse if you lie flat?

P: No.

D: OK, and has this headache been getting worse, staying the same, getting better?

P: It's it's about the same.

D: OK. Um and, um and you haven't checked the temperature yet, you said, but you felt hot?

P: Yes, that's right.

D: OK, any other symptoms that you've been experiencing?

P: Not that I can think of.

D: OK, there's just a few others that I wanted to ask about to be comprehensive. Have you had any eye pain or ear pain?

P: No.

D: How about any discharge from either your eyes or ears?

P: No, nothing like that.

D: Alright, have you had any changes to either your sense of smell or your sense of taste?

P: No.

D: Alright, and have you had a runny nose at all?

P: Um no.

D: And how about a sore throat?

P: No.

D: OK, and um, have you had any chills?

P: Um no chills.

D: How about night sweats?

P: Um no nothing like that.

D: I see, OK and over the last few months has your weight changed?

P: Ah no, not that I noticed.

D: OK, um have you been feeling tired or fatigued?

P: No.

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

P: Um no.

D: Alright, and how about any heart palpitations?

P: None.

D: Alright, in any episodes of feeling really dizzy or lightheaded.

P: No.

D: OK, and how about any fainting spells or feeling like you might faint?

P: No, nothing like that.

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

P: Um no, no abdominal pain.

D: Any diarrhea or constipation?

P: No.

D: How about any painful urination or feeling as though you need to urinate really frequently?

P: Ah no nothing like that.

D: OK, and have you had any skin changes like rashes or anything like that?

P: No.

D: OK, and how about any muscle aches or joint aches or just overall like body pains?

P: Mmm no, not that I that not. Not that I've noticed, no.

D: OK, is there anything in regards to your past health that you see a physician regularly for?

P: Um No. Ah actually I I think at one point, um, I was worked up for something called familial hypercholesterolemia because it ran in the family. But I think those results were normal.

D: OK, so do you, um, do you take a statin medication then?

P: Yeah I take a low dose statin.

D: OK, and when was your last lipid panel checked?

P: I think it was two years ago.

D: I see, and um do you remember if the LDL was normal at that time?

P: Ah yes it was normal.

D: OK, but since the, it was about two years ago, it might be worthwhile today just to also check a lipid panel just to be safe, but that'll be something we can talk about that more so at the end if that's OK.

P: Sure, yeah, that would be great.

D: OK, and any other medical conditions?

P: No.

D: OK. Have you had any surgeries before?

P: C-section.

D: How many children do you have?

P: Ah just the one.

D: OK, and were there any complications with the c-section?

P: Um no no complications.

D: OK, any reasons for hospitalizations?

P: Nope.

D: OK, any allergies to medications?

P: No.

D: Alright, any medications besides the statin that you take?

P: Nope.

D: OK, and in regards to your family history, have there been people who've had early heart attacks or strokes in the family?

P: No.

D: OK, but you do have familial hypercholesterolemia, do you have family members who have that?

P: Yes OK so my Aunts had it, as well as my mother.

D: OK um. And has there been any lung conditions that run in the family?

P: Um, no lung conditions.

D: How about any malignancy's or or cancers?

P: Ah there was colon cancer on my dad side of the family, but I'm not too sure who had it.

D: OK, have you heard of anybody having breast cancer?

P: Breast cancer no.

D: Alright, and how about ovarian cancer?

P: No ovarian cancer.

D: OK. And next I actually wanted to ask a few questions about your personal and lifestyle habits, but first, could you just tell me a little bit about your living situation right now?

P: I live with my husband and my one son.

D: OK, and sorry, how old is your son?

P: He is 10.

D: OK, um is anybody in the home been sick recently?

P: No.

D: OK, and how about is there anybody at work?

P: At work no. No one's been sick.

D: OK, have you traveled anywhere recently?

P: We went up to we just went to um like a, we went on a hiking trail that was outside the city recently and there were a lot of people there and and we weren't wearing masks, but we, it seemed like we were keeping a good distance between each other so that that would be my only concern.

D: OK for sure. Were people pretty close to each other on the paths when walking by on the hike?

P: Ahh not like the whole time, but there would be times when you know people just kind of brushed by you to try to get ahead of you or something like that.

D: I see OK. And do you smoke cigarettes?

P: No.

D: Um, do you smoke marijuana?

P: Um no.

D: OK, and do you drink alcohol?

P: I don't.

D: Do you use any other recreational drugs?

P: Um no.

D: OK, so that was all I wanted to ask about. Oh, actually one thing that I I did want to, I forgot to ask was, do you have any neck stiffness?

P: No, not that I noticed.

D: OK. So that was the last question that I wanted to ask about. Was there anything that you wanted to tell me that I I maybe forgot?

P: No, I think you covered it all.  I'm just wondering do you? Do you think it's COVID or something else?

D: Well, it's definitely a possibility with the symptoms that you're having, since they can be so non- specific for covid it can be a lot of symptoms that overlap. So with having headache what sounds like you might have a fever and and this cough that sounds like it's pretty bad if you're bringing up some blood, it sounds like you might have irritated some of the bronchioles with the the coughing. So we will test for that and check a PCR nasal swab for COVID. I'm not, but we will also test for other viral illnesses and bacterial illnesses as well. It doesn't sound like you have meningitis right now just based on the symptoms where you don't have neck stiffness, but it'll be certainly something that we keep keep in mind while we are doing our investigations.

P: OK great, thank you.

D: Alright, you're welcome. We'll get those started.

P: OK, sounds great.


D: How may I help you?

P: I um. I just haven't been feeling very well over the past couple months. And I have decided I just come in and see what's happening, so I've just I've been feeling short of breath. And I kind of passed out sometimes and I'm really worried about it.

D: OK. Uh, so when the shortness of breath start.

P: I say about five or six weeks ago.

D: OK, and and do you get short of breath at rest?

P: No.

D: And has it been getting worse or staying the same?

P: Uhm? Kind of the same maybe a little bit worse, but I yeah maybe the same. Definitely not getting better.

D: OK, how far are you able to walk or exert yourself before you're short of breath?

P: I can walk quite a bit, um, but I, I guess like when I go for my my runs in the morning, I start feeling short of breath. It's maybe like, two blocks or three blocks.

D: OK, and any any symptoms where you get short of breath at night and where you had to get up and and put your feet over the bed?

P: No.

D: Are you able to lay flat without being short of breath?

P: Uhm, yeah

D: Or does it.. OK. And every had any swelling in your feet or ankles.

P: No.

D: OK, and you mentioned that you you passed out as well. Can you tell me a little bit about a little bit about that?

P: Yeah, uh, it just happened two or three days ago. And I was just, I was-I wasn't really doing much I was I guess just like going up the stairs. And when I got to the top, I just kind of suddenly collapsed. And then I got back up.

D: Were you really short of breath at the top of the stairs?

P: I felt like my heart was like beating kind of fast. And I felt little bit dizzy.

D: OK, see, where you sweaty at the time as well?

P: I don't remember, maybe?

D: OK, did you feel like you were going to pass out?

P: Yeah.

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

P: No. No.

D: OK and did you bite your tongue during this or?

P: No.

D: OK, and did you wet yourself at all? Like pee your pants or anything like that?

P: No.

D: OK. And how long did it last for?

P: Maybe a couple of seconds, it's. Yeah. I don't know, I I can't really tell. I was alone at home at the time. And I'd like I couldn't tell how long it took for me to get back up.

D: OK, you picture that your heart was racing. Did it feel like it was like did you have heart palpitations or is your heart beating really fast?

P: Yeah it was.

D: OK. And did you hit your head or or hurt yourself when you fell?

P: No, no.

D: OK, and recently, have you been otherwise feeling well or if you had any viral infectious symptoms like red eyes or itchy eyes or runny nose, sore throat?

P: No.

D: OK, nothing like that and have you had a cough?

P: No.

D: OK. And have you had any wheezing?

P: No.

D: And if you had any chest pain.

P: No.

D: OK, have you had any instances where you felt as though you were having heart palpitations at any other times? And not just during the time that you had the fainting episode?

P: Um, I kind of did when I was. When I was like running outside, but I just thought maybe maybe I was exerting myself too much.

D: I see, alright. And any chest pain?

P: No.

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

P: No.

D: Any abdominal pain?

P: No.

D: Any urinary problems?

P: No.

D: OK, any muscle aches or body pains?

P: No.

D: Any fevers or chills?

P: No.

D: Have you had any changes to your weight in the last several months?

P: No.

D: Have you had any changes to your appetite?

P: No.

D: And have you notice any skin changes like rashes or or anything like that?

P: No.

D: OK. And. Uh. In the past, have you been diagnosed with any medical conditions?

P: No, I've been very healthy.

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

P: Uhm, I just take some puffers for asthma, but I haven't had asthma in awhile. I actually thought maybe my asthma was getting worse over the past two three months. I didn't really. I just I didn't think too much of it. But then when I fainted, I was just kind of scared.

D: Yeah, for sure. Umm, certainly would be frightening. OK, and do you use the inhaler everyday?

P: No. I used to when I was young. I didn't have asthma for a couple of years for like, I'd say 20 years or so. So then I stopped taking inhalers.

D: OK, so you haven't used them recently.

P: No.

D: And any allergies to medications or, uh, environmental?

P: No.

D: OK, and if you had any hospitalizations or surgeries?

P: No.

D: OK. And have you been pregnant in the past?

P: Uhm, I I was yeah. I have a son. About eight years ago. He was born eight years ago.

D: Ok. Was this a vaginal delivery or a C-section?

P: Vaginal.

D: And any complications, either during pregnancy or delivery or afterwards?

P: Oh no, everything was good, no problems.

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

P: Yeah, I'm living with my husband and my son. We live in a house about 30 minutes from here.

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

P: No, everyones been well.

D: Alright, have you traveled anywhere recently?

P: No.

D: OK, any exposures in the house like carpets or rugs or it's like like things like that?

P: We do have carpets, but I mean I, I don't think that's a problem. Like we've had it for like years and we've had the same carpets for years and years.

D: OK, I see and are you working currently or or at home?

P: Yeah, I'm at home but I work from home. I'm a writer.

D: OK cool, yeah I do you smoke cigarettes?

P: No.

D: Do you smoke cannabis or use any cannabis products?

P: No.

D: OK, and do you drink alcohol?

P: I do, I'll just drink on the weekends.

D: OK, and I like how many drinks would you typically have in a week?

P: Uhm, not much. I'd say one or two glasses of wine.

D: OK, do you use any recreational drugs?

P: No.

D: OK, And like you said, you're a writer currently. In the past, did you work any jobs where you were exposed to asbestos or like any chemicals or fumes in the air?

P: No, no, I haven't.

D: OK, And in the family is there is there anybody who has any heart or lung conditions?

P: No.

D: How about any clotting disorders or or cancers?

P: Uhm, prostate cancer. My uncle had it.

D: I see, OK. So it sounds like over the last little month, you've been having some more short shortness of breath as well as well this fainting episode more recently. So we will. Was there anything else that you wanted to add?

P: Hum, no.

D: Alright, so we will do some pulmonary function testing and get some imaging of your lungs today as well as an ECG and maybe a monitor for your heart as well to just check your heart racing for the next 48 hours. Mentioning that your heart was racing and so to rule out that any abnormal rhythms of your heart, or to check for that. And we will kind of go from there, did you have any questions?

P: No.


D: Uh, how can I help you?

P: Uh, I have just been feeling very short of breath recently.

D: OK.

P: And I thought I should come in. I've also had a, I've also had a cough.

D: I see. OK, uhm, and when does this shortness of breath, uhm, come on? How, how much activity are you able to do?

P: Uhm, I can walk a block.

D: OK.

P: Without being short of breath.

D: And prior to this change, how far were you able to walk and and how long ago did you, did you notice this change?

P: Uhm, I, I guess I could walk, uh, I don't know, it's been very, I guess it's, it's been a gradual change. Uhm, maybe a month, a month ago I felt that I couldn't really walk as much as I used to, and then it's only gotten worse. Two or three months ago I could, I could walk a kilometre or two, or more.

D: OK, so quite a significant change over the last little while. Have you had any episodes where you wake up in the middle of the night with, with shortness of breath, and you need to sit up?

P: No.

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

P: One.

D: OK and have you noticed any like ankle swelling or or leg swelling?

P: No.

D: OK. And you mentioned cough. When did that start?

P: I've had a cough for a while, the past five, ten years, but I feel that it's been a little bit more frequent now. It's just, I just get into this coughing fit and I think there was a time when I had a little bit of blood come out as well, once or twice. The coughing also makes it difficult for me to breathe, you know, I feel very short of breath after that.

D: Yeah, certainly, uhm, how much blood have you coughed up?

P: Oh, I don't know. I think it was it was a little bit.

D: Did it happen each time, or has it only been a couple of times?

P: I think maybe, two or three times but then there have also been times when I cough up this, this stuff that I cough up is a little bit pink in color. It's not exactly blood, but it's, it's, you know, pinkish.

D: OK, and are you producing sputum each time you're coughing up?

P: Most of the times, yes.

D: OK, is this a change from previously? Did you have a dry cough before?

P: A bit more of a dry cough before, but I mean, so sometimes it will be a dry cough sometimes, uh, it was more of a wet cough, but it was, it was usually just this white thing coming up. It wasn't like, there was never blood before.

D: OK, and you're coughing more often as well over this last month?

P: Oh yeah, Oh yeah,

D: OK. Have you been experiencing any, any headaches?

P: No.

D: OK, how about any eye pain or ear pain?

P: No, no, no.

D: How about any eye redness or, or discharge?

P: Nope.

D: Any runny nose or sore throat?

P: no.

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

P: Uhm, I, I checked my fevers, I checked my temperature uh, couple days ago. It's just been this little bit, 30, I think it was 38.

D: OK, so, yeah, that would be a fever.

P: That was I think two weeks ago.

D: OK, do you feel hot now?

P: Not really, no.

D: OK. Have you had any night sweats?

P: Uh, no.

D: And have you had any weight loss over the last several months?

P: Oh, yeah.

D: How much weight?

P: About 20 pounds.

D: OK, and so how, How long was that weight loss over?

P: I'd say about about, uh, three, three-four months?

D: OK and sorry, what was your starting weight, roughly?

P: Yeah, yeah I was, uhm, 210 pounds.

D: OK, uhm, so yeah, about a 10% reduction in your weight over the last couple of months, it sounds like. OK, How is your appetite been?

P: Uh, it's OK.

D: Alright, and have you been having any chest pain?

P: No.

D: Any, any wheeze?

P: No.

D: Have you had any dizziness or lightheadedness?

P: Uhm no, no.

D: OK, how about any nausea or vomiting?

P: No.

D: Any diarrhea or constipation?

P: No.

D: Any urinary problems?

P: No.

D: Any skin rashes or muscle aches.

P: No.

D: OK, and, uh, have you been diagnosed with any medical conditions before?

P: Yeah, I've been diagnosed with COPD, with, uh, high blood pressure and high cholesterol.

D: I see, alright and do you take any medications for those?

P: Uh, I take Lipitor.

D: OK.

P And I take some puffers but don't use them very frequently. I forget to use them. And they, I tried them, but they haven't been very helpful these past two months.

D: OK, so yeah, you've tried them, when you were short of breath and they haven't helped?

P: They haven't done much.

D: OK. And are you allergic to any medications or have any allergies?

P: Uhm, no.

D: Alright, and have you been hospitalized for any reason, or like, including COPD exacerbation?

P: Oh yeah, yeah.

D: Or any similar symptoms?

P: It's been, uh, I was, uh, I was actually hospitalized about four or five times last year.

D: And was this for COPD exacerbations?

P: Yeah, yeah.

D: OK, did those each require a stay in the hospital?

P: Two or three of them I did, yeah.

D: OK. And have you had any surgeries?

P: Uh, no.

D: And are you currently smoking?

P: Yeah.

D: OK, how much do you smoke per day?

P: I've got it down quite a bit. I only have two cigarettes a day. I used to have a pack and a half, Uh, but I've got it down a lot. I'm trying to, I'm trying to quit, but it's hard.

D: Yeah, for sure it's great that you're working towards quitting. We can discuss that further and there are several options that might be available to help if it's something you're interested in, because yeah, it's definitely really hard. Are you, do you drink alcohol?

P: Uh, once in a while, on Christmas.

D: OK, and do you use any recreational drugs?

P: No.

D: You smoke marijuana or use marijuana products?

P: No.

D: Alright, and who are you living with currently?

P: I live with my wife.

D: OK, and are you, uhm, do you help looking after the home, and uh, like functionally independent right now?

P: Uh, yeah. I use a cane.

D: Mhm, ok.

P: And uh, yeah, my, my son comes over and helps out with groceries and my wife cooks but, I, I help her with cleaning sometimes.

D: OK, great and, so are you retired?

P: yep.

D: OK, uhm, and has anybody in the family had any heart or lung conditions?

P: My dad died of lung cancer. He was a, he was a big smoker as well. And my mom had a heart attack.

D: OK, and how old were your parents approximately?

P: Yeah, my dad was 65 and my mom was, was very young, she was 50.

D: I see. Did your mom survive the heart attack?

P: No, no she did not.

D: Oh, I'm sorry to hear that. Uhm, and the lung cancer you mention, any other cancers that run in the family?

P: No.

D: OK, so that was all the questions I wanted to ask on on history. Uhm certainly it sounds like you're bringing up some blood with, with, with the increased cough and with difficulties breathing so we will get a, uhm, a chest x-ray and possibly a CT image of your chest as well to see if there's anything going on in your lungs and we might do some blood work as well to check a few things so uhm, we'll get those ordered and, and see what, see what that shows.

P: Thank you.


D: So what brings you here today?

P: Yeah, so I've had this cough, ongoing now for the last three days and I found I've had a more difficult time breathing as well.

D: OK, and So what came first? did the cough come first?

P: Yeah, the cough started first.

D: OK and so it started three days ago?

P: Yeah.

D: When did the shortness of breath start?

P: That started probably about two days ago.

D: OK, and the cough, can you describe it a little bit? Is it like a wet cough, a dry cough? How would you describe it?

P: Yeah, I brought up a little bit of sputum. It's been clear, mostly clear and sometimes dry as well. The cough's been getting worse over the last couple of days as well and hasn't really stopped either, it's just kind of ongoing all day.

D: OK, so it's it's pretty constant?

P: Yeah, it's been constant.

D: OK, and how much sputum would you say you're bringing up?

P: I would say, uh, maybe like two teaspoons a day. It's only like a little bit in the tissues and I'm not bringing up sputum every time.

D: OK, and is your sputum at all yellow, green? Or does it have any blood tinge content in it?

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

D: OK, so it's mainly just white or clear.

P: Yeah, it's mostly, yeah, like whiteish or clear.

D: OK, uhm, and have you had anything like this happen before?

P: No, I haven't.

D: OK, and how would you describe the shortness of breath? Are you having trouble taking deep breaths or are you having trouble breathing when exerting yourself, like how would you describe it?

P: Yeah, I have like, a chest tightness. I find when I exert myself it gets worse and after I cough, I have a little bit of trouble catching my breath as well.

D: OK, When do you have the chest tightness, when did that start?

P: Uh, yeah, that's started within the last two days as well, with the cough.

D: OK, so is it just the tightness when you cough or is it there just throughout?

P: Yeah if I take like a deep breath in, like, it just feels tight, like I can't get a deep breath.

D: OK, and have you had any kind of, like swelling in your calves, or pain in your calves at all?

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

D: OK, and have you had any surgeries recently or have you been immobilized for a long time or admitted to a hospital or anything like that?

P: No, I haven't had anything like that, I've been healthy.

D: OK, and have you had anything like a blood clot, either in your legs or traveling up to your lungs in the past before?

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

D: OK, and have you been diagnosed with cancer or any other medical conditions?

P: No, I haven't.

D: OK uhm, so would you say the coughing and the shortness of breath is getting worse, or it's about the same?

P: I'd say it's gotten a little bit worse over these last couple of days.

D: OK, and is there anything that makes your symptoms better or worse?

P: Yeah, if I exert myself it does make it a bit worse. It'll bring on the cough more, and shortness of breath.

D: OK, and how about any positional changes? Like, does lying down help? Does resting help relieve some of that tightness, cough and shortness of breath?

P: No, nothing like that has helped.

D: OK, and have you tried any kind of medications at all, over the counter?

P: No, I haven't tried anything.

D: OK. Alright, so it seems that your shortness of breath, is it, uh, mainly when you're breathing in or breathing out? Or are you having shallow breaths? How would you describe it?

P: I would say it, yeah, I kind of go back to the chest tightness, it just feels like I'm not able to, like, breath in all the way and catch my breath after I exert myself or coughing. It's easy Uh, like if I rest I'm not short of breath.

D: OK, do you have any other symptoms? like a runny nose, sore throat? Anything like that?

P: Uhm, nothing like that.

D: OK, and any headaches?

P: I have had a little bit of a headache over the last day. Usually I get headaches like this when I haven't slept well.

D: OK, and is it like a different type of headache and is it on one side of your head or both?

P: Yeah, I feel it on both, kinda like right up into my forehead there.

D: OK, and is it kind of like a pressure like pain? Is it pulsating pain? How would you describe it?

P: I would say it's more of a pressure, yeah.

D: OK, uh, have you tried any medications for it?

P: Uhm, Yeah, I took an Advil this morning. It's taken the edge off a little bit. I will use that sometimes when I get headaches.

D: Are you having any nausea or vomiting?

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

D: OK, and have you traveled outside of the country or outside of the province at all?

P: No, I haven't.

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

P: I don't think so. I work at the Toyota factory and there have been a few people that have been sick who worked there? But I don't think I've been in contact with them.

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

P: I have felt pretty hot, yeah, I was sweaty last night, I didn't check a temperature, but I felt feverish.

D: OK, were you having night sweats?

P: My bed wasn't drenched or anything but I was sweating.

D: OK are you feeling like you have lost any sense of taste or smell at all?

P: Uhm, Yeah, I haven't been able to smell very well.

D: OK, and when did that start?

P: That may be within the last two days as well.

D: OK, and are you congested at all? Like, do you have a runny nose or anything like that?

P: No, I don't have anything like that.

D: OK, yeah, any changes in your bowel movements, like any Constipation or diarrhea?

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

D: OK, any muscle aches?

P: Yeah, I have felt a bit sore.

D: Where would you say you feel sore?

P: Just kind of all over, my whole body just kind of feels a bit achy.

D: OK, and when did this start?

P: Yeah, probably like last night, this morning when I was laying down and just felt a bit tired and achy?

D: OK. Has your sleep or appetite changed at all?

P: I didn't sleep very good last night. I just don't feel very rested this morning. And yeah, I haven't felt very hungry either.

D: OK, uhm, alright, do you have any medical conditions that you take any medications for?

P: No, I don't take any medications.

D: OK, and have you had any surgeries or have been hospitalized before?

P: I did have tubes in my ears when I was little, but that's it though.

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

P: Yeah, my dad had a triple bypass surgery done last last year. He was sixty-three at the time and that's about it.

D: OK, and you don't have any high blood pressure or anything like that, right?

P: No, not that I know of.

D: OK, and do you have any allergies?

P: Uhm, just environmental stuff I think, just, like in the springtime, I'll get itchy eyes or a runny nose.

D: OK, and currently do you work?

P: I do, yeah I work at a car factory nearby, just on the assembly line.

D: And have you been off of work right now, with your symptoms? How is that going?

P: Oh yeah, just like these last two days I called in and I let them know and I left work early yesterday when I realized that I was feeling sick and didn't go in this morning.

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

P: So I live with my girlfriend, and we have a son who's four years old.

D: OK, and any one of them having any similar symptoms?

P: No, they've been good. My wife works from home and my son, he's been his playful self.

D: OK, that's good. OK, last few questions. Do you smoke at all?

P: No, I don't.

D: Do you use any recreational drugs like marijuana?

P: Uh, no, I don't.

D: OK, and do you drink alcohol?

P: I'll have some wine with dinner, maybe two or three nights a week.

D: OK. Yeah, those are all the questions I had today and it seems that definitely there are some concerning symptoms like the shortness of breath and the cough especially also the loss of smell that you're having. We definitely want to make sure that you don't have coronavirus, so we will do a test for you today. And what we recommend in the meantime is to self isolate, even in your home, wear a mask around your family, if you can, like, eat separately, don't go outside and be off of work until the test results come back and then even after that, you might need to follow instructions of public health and self isolate for 14 days. If not coronavirus, hopefully, then it can also be other things, like, other viruses can cause similar symptoms as well, but yeah. So, we'll just get that test done and then see where to go from there.

P: OK, that sounds great. Thank you.

D: You welcome. Take care, bye.