D: What brings you in?

P: Hi, I'm just coming in here today because I've been just on wall recently over the last, I would say three to four days. I started getting these like really bad muscle pains all throughout my body and then over the past few days I've also been feeling chilly, so uhm, I wonder if I have a fever and I've also just been having this cough for the last few days as well.

D: OK, what started first?

P: I think the muscle pain started first and then it was the coughing then since yesterday, I think I might have a fever as well.

D: OK. The cough started ,or the muscle aches started first. Was that two days ago, three days ago?

P: Almost four days ago now.

D: Four days, OK, and the cough started when?

P: Cough started three days ago.

D: OK, OK. Uhm before the muscle aches started, did you like do anything different in your life, like you know, do a lot of exercise or any other strenuous activities?

P: No, I I haven't really changed my routine at all.

D: OK, and where specifically like wha, which muscles ache?

P: Pretty much like throughout my body, but I would say more so like upper back, my thighs, then my arms, yeah, kind of just all over.

D: OK any joint pains as well?

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

D: OK. And is it hard for you to walk like use your arms? Do you have any sort of like motor weakness?

P: Uhm, it's not, I I can walk and there's no issues, but I I do feel like just overall general weakness. I don't know if that's to do with the pain or just feeling unwell.

D: OK, so you're able to do those things. You just feel like maybe you're tired?

P: Yeah.

D: OK. Any numbness or tingling?

P: No.

D: No, OK. The cough, is it a dry cough or like productive cough? Are you bringing up phlegm?

P: It's a dry cough.

D: A dry cough, OK. Uhm, so no sputum or blood, right?

P: No.

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

P: Uh, no.

D: Sore throat?

P: No.

D: Shortness of breath?

P: No.

D: No, OK. Wheeziness?

P: No.

D: OK, any fevers?

P: And I have been feeling chilly over the last few days, just, I have been wearing like multiple layers having to put on an extra blanket so I might have been having a fever.

D: OK, but you haven't taken your temperature, right?

P: No.

D: OK. Any weight loss?

P: No.

D: Changes in your hair, nails or skin like rashes?

P: Not that I've noticed.

D: OK. Changes in your vision or hearing?

P: No.

D: Taste or smell?

P: No.

D: Chest pain?

P: Oh sorry. Now that you mention I, I think taste a little bit today, I realized I was I wasn't really able to taste my breakfast.

D: OK. So a little bit of change there?

P: Mhmm.

D: OK. And any chest pain?

P: No.

D: OK, any feelings of like feel like feeling like your heart's racing?

P: No.

D: OK. Uhm, how about uh like calf pain when you do a lot of walking?

P: No.

D: Fainting or dizziness spells?

P: No.

D: OK, any changes to your bowel movements?

P: Uhm, no.

D: OK, and any nausea or vomiting?

P: No, no nausea or vomiting.

D: OK, uh how about appetite changes?

P: Uhm, appetites been the same.

D: Any changes in your urine?

P: No.

D: Headaches?

P: No.

D: Confusion or memory loss?

P: No.

D: OK. Uhm, alright so are you otherwise healthy or do you have any longstanding medical conditions?

P: Uh no, otherwise I've been pretty well haven't even really had to go to the doctor much in the past few years.

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

P: No.

D: No, OK. And how about medications, are you on any?

P: Uh, no medications.

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

P: Yep.

D: OK, and how about allergies, do you have any?

P: No, not that just like uh, seasonal allergies I sometimes get just itchy eyes and runny nose, sneezing in the springtime.

D: OK. And do your current symptoms feel like that?

P: No, no.

D: No, OK.

P: I feel completely different.

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

P: Uhm, think my uncle had a heart attack in his 50s.

D: OK.

P: And I think my father has high blood pressure.

D: OK. OK, any cancers in the family?

P: Uh no, not that I know of.

D: And then do you smoke?

P: Uhm, just socially sometimes when I'm with friends, not-nothing regular.

D: OK, and so for the past like two months, how often have you been smoking?

P: Probably a couple cigarettes on the weekend. We usually smoke marijuana, so not not too much like tobacco or cigarettes.

D: OK. OK. Uhm, do you do any other recreational drugs like marijuana, cocaine?

P: Just marijuana, no other drugs.

D: OK, do you smoke it or edibles.

P: Smoke it.

D: OK, and how often do you smoke cannabis?

P: Probably just when I'm meeting up with friends. So every weekend I would say.

D: Every weekend?

P: Yeah.

D: OK. And then how about an alcohol, do you drink alcohol?

P: Yeah, I drink alcohol probably a couple of drinks every few days.

D: OK. OK. And sorry what kind of alcohol do you drink every few days?

P: Just mostly beers, maybe whiskey sometimes.

D: OK, and how much of that?

P: So probably a couple beers. Uhm every few days and then whiskey, maybe a normal glass every few days, so yeah I would say 3 or 4 beers a week and then maybe 2 glasses of whiskey. In a, in an average week.

D: OK, OK. Alright, and have you been in touch with or in contact with anyone sick recently?

P: No, no one's been sick. Uhm I do meet up with some friends on the weekends. Some of them are from work, some of them are just that that I know outside of work.

D: OK. OK, uhm and have any of them been sick or have they all been pretty healthy?

P: Uhm, in heard from anyone that's been sick. We we kind of have a rule that if you know if we feel sick then not to, not to show up just because, like you know, when we're when we're drinking and like smoking, we may share like a joint, so it's not like we don't want to get everyone sick if one person is sick.

D: Yeah for sure. Uhm, that makes sense. Alright, any travel recently?

P: No.

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

P: Right now I just live in an apartment by myself just outside of London.

D: OK. Any old carpets, dust, mold, asbestos anything that could make your condition worse?

P: No.

D: OK, so those are all the questions that I had for you. Did you have any questions of your own for myself?

P: Uh no, I don't think so, I just wanted to see what this might be.

D: Yeah, for sure. Uhm so, we are going to do a Covid swab on you because a lot of your symptoms do align with those of Covid, so we just want to rule that out first, so you should hear back in about 24 to 48 hours. Uhm, in the meantime you should isolate for two weeks and if it's not Covid, it could be another viral infection that's been going around this time of year. Either way, kind of management plan is the same, so make sure you're hydrated, eat well, sleep well, and if your symptoms become worse, severe or there any red flags like you have neurological symptoms, like seizures or weakness where you can move your limbs, you should seek help from the ER. How does that sound?

P: OK. That sounds good. Thank you.

D: OK yeah, no problem.


D: What brings you in here today?

P: Hi, hi there I've been having this knee pain. It started almost immediately after I was I was playing basketball on the high school team and it was during practice I jumped up for a rebound and I, when I landed I heard a pop of my my left knee and I immediately felt pain. I just went off to the off to the sideline.

D: OK, and when did this happen?

P: Uh, this happened about. Probably like 6 hours ago. Maybe like a few hours ago.

D: OK, OK, I see and since then have you been able to walk at all or have you been just, has it been very difficult?

P: At first I was able to kind of limp off the court, but since then I I haven't really been able to walk. It's gotten pretty swollen since then and it looks bruised as well.

D: OK, it's swollen and bruised in what kind of pain are you having, is it like sharp or is it aching?

P: It's pretty sharp. It feels like there's people just stabbing me in the knee.

D: OK. Uhm And um, do you have any, so you're having pain in your knee. Has it gone worse than when it started?

P: Um. Yeah, it's yeah it feels a bit more painful than it did earlier. I think maybe the adrenaline was pumping a little bit. But yeah, now it's it's pretty pretty painful.

P: OK OK uhm. And how much would you rate the pain out of 10, 10 being the worst pain you've felt in your life?

P: Oh, I'd say this is like a 9 or a 10, this is it's really painful.

D: OK, are you having pain anywhere else or is it just your left knee?

P: Just my left knee.

D: OK alright. Are you having other symptoms like fainting, dizziness?

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

D: OK, and are you having any fevers, chills or anything like that?

P: No fevers or chills.

D: OK. Any kind of numbness or tingling at all?

P: No no Mr tingling.

D: OK. Is the pain moving anywhere else from your knees?

P: Uh, no I just feel like pretty like just right in my in my knee.

D: OK, and what kind of motions are hurting you right now the most?

P: I would say just like bending my knee, like, yeah, flexing my knee up as well as, like if I try to put any weight on it like I can't walk on it right now, I can't put any weight on my knee right now. And also even straightening it out hurts as well if I'm really flexing the muscle, so just trying to stay pretty immobile right now.

D: OK, I see. OK, and in terms of other symptoms, any kind of chest pain, shortness of breath?

P: No, nothing like that.

D: OK, any rashes or skin changes?

P: No, the only skin change that I that I have is the like bruising or looks like you like blood around my knee.

D: OK you see is it warm to touch?

P: Um. No, no, it's not warm.

D: OK. In terms of your past medical history, any conditions you've been diagnosed with in the past?

P: No, I've been healthy.

D: OK, any medications that you take regularly?

P: No, I don't. I don't think anything regularly.

D: OK, any allergies to any medications?

P: No, I don't.

D: OK, any hospitalizations or previous surgeries?

P: No, nothing like that.

D: OK, and any family history of any musculoskeletal or rheumatologic conditions?

P: Um, no no, nothing like that I I I mean I think my dad I had a rotator cuff injury or something like that but I mean he's in his 50s now so I think that happened at work or something I don't know.

D: OK. Uhm, OK, and other than that, do you, so are you at school right now?

P: I am yeah, I'm in grade grade 10 and playing well playing on the the high school basketball team and that's how I got this injury here.

D: And have you had a similar injury at all in the past?

P: No, I mean I'm I've I've sprained my ankles in the past, which would go would heal with some rest after a few days I never got those checked out because they're they weren't so bad, but I've never injured my knee before.

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

P: So I live with both of my parents and I also have a younger sibling. A sister, she's 8 years old and we have a dog as well.

D: OK, uhm. Alright, and have you experimented at all with any recreational drugs, alcohol, or smoking cigarettes?

P: No, nothing like that. I see kids at school um smoking and stuff, but, you know, as an athlete, I try to stay away from that kind of stuff as much as possible.

D: OK, no, yeah, that's really that's really good that you're thinking like that. Any issues at school like bullying or do you feel unsafe either at home, around your home environment or at school?

P: No, I don't feel unsafe. I mean, I know there's always those kids at school who are mean to others. But I mean, I, I generally feel safe.

D: OK, alright so I'm just going to ask a few questions about just the examination part of part of this. Do you, so you mentioned you can't flex your knees at all, can you extend them?

P: Yeah it it can, uh, straighten it out all like most of the way, it seems like it's bent a little still maybe from like the swelling and only I can't straighten it out the full way.

D: OK, and then you said you noticed like bruising and kind of like there's blood accumulating in that area?

P: Yeah exactly yeah, it looks like it. 'cause it's a bit like Brown. I guess I can like see or on my knee I guess like the like a big bruise.

D: OK, I see. OK. And. Yeah, so those are kind of like all the questions I had for you. It seems that based on the description of how the injury happened an the mechanism and what you're feeling right now and in terms of the examination, it's possible that you had knee ligament injury. Most likely in this case, the anterior cruciate ligament, but just to make sure we will need to do an MRI of your knee and see which ligament is affected and to what extent. Uh, and usually with the with the depending on what we find on the MRI sometimes it can be just conservative management, but however oftentimes you do require surgery, so it would be. Just a surgery where we put kind of like a scope in into your knee and through the scope we try to fix the ligament. So yeah first, we'll just do the MRI and see to what extent your knee injury is and how how affected the ligaments are, and then we'll go from there. Does that sound OK?

P: It does. Yeah yeah, thank you.

D: Welcome alright, Take care.


D: What can I do for you?

P: Hi there, yeah I've had this pain in my knee that's been going on for a few weeks now and it hasn't gone away and and so I thought I would get checked out. It's been really impacting my running. I just haven't been able to run as often as I would like to and so that's why I wanted to get this looked at.

D: Yeah, for sure. You said it started a couple of weeks ago. Was that two weeks ago, three weeks ago? Or more than that?

P: Yeah, I would say maybe it's been going on for the past four weeks, for the past month.

D: Past month. OK. And is it a constant type of pain or does it come and go?

P: It comes and goes, yeah, and it depends on what I'm doing.

D: OK. Uhm, alright and what kind of makes it worse or better?

P: So if I'm out while running, what will bug it, but I think like that the main things that hurt are if I'm walking down stairs or if if I'm squatting. I like to lift weights as well, and yeah, I could barely even do body weight now 'cause if I I'm squatting down it causes a lot of pain, it's a sharp pain.

D: OK. OK, and if you were to describe the quality of your pain, would you say it's achy, throbbing, dull, sharp, burning?

P: Uh, it's a sharp pain.

D: Sharp pain, OK. And one to 10, 10 being the worst pain you've ever had. How bad is this pain?

P: It's about a 7.

D: 7. And have you ever had pain like this in the past?

P: Uh, no, I haven't.

D: OK, and do you feel like your pains getting worse over the past four weeks?

P: Uh, yeah it has gotten, has gotten a bit worse.

D: OK, uhm, alright, and do you, are you experiencing any sort of muscle weakness?

P: No muscle weakness.

D: No, OK. How about numbness or tingling?

P: No numbness or tingling.

D: Headaches?

P: No.

D: Confusion or memory loss?

P: Nope.

D: Any joint pains or muscle aches outside of the area of this left knee?

P: No, just, just the left knee.

D: And whereabouts on the left knee, is it?

P: It's on the anterior aspect. Like on the front of it, but I I could, it feels like the pain is right behind my like right underneath the kneecap.

D: Right underneath the knee, OK.

P: Yeah.

D: OK. Alright and otherwise like have you had any weight loss?

P: No, my way it's been the same.

D: OK, how about fevers or chills?

P: No fevers or chills.

D: OK. How about fatigue?

P: No fatigue, energy's been good.

D: OK. Changes in your hair or nails like rashes?

P: No, nothing, nothing like that.

D: OK. Changes in your vision, hearing, smell or taste?

P: Nope, that's all been normal.

D: OK, alright. How about coughing, shortness of breath, or wheezing?

P: Uh, no, not not-nothing like that.

D: OK, chest pain or heart palpitations?

P: Nope. No chest pain or or anything like that.

D: OK. Any changes in your bowel movements?

P: Nope, I haven't had any diarrhea or any blood.

D: OK, any changes in your urination?

P: No.

D: No, OK. Alright, and are you otherwise healthy or do you have any longstanding medical conditions?

P: I do have, ah, asthma, so I I do take a, an inhaler. I have a daily, a daily one that I'll use and then, just a, like rescue one. So like the blue one that I'll use sometimes, but I haven't needed that one for for awhile. I've been pretty good. I don't even need it when I'm going or runs anymore.

D: OK, OK that's good. And are you on any medications?

P: Yeah, just the just the inhalers and then I took uh, birth control as well. I've been taking that since I was 16 so, yeah, so for like 6 years? 7 years?

D: OK alright. And are you, have you been hospitalized or had surgeries in the past?

P: No, I haven't had any.

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

P: I am, yes.

D: OK, how about allergies? Do you have any?

P: Uh, I, uhm, I don't, no.

D: No allergies, OK, good. And any family history of musculoskeletal issues.

P: Uh, no, ah, well, I think my grandparents have like osteoarthritis or something like that. They, but, that's it.

D: OK. Uhm, how about longer heart conditions?

P: No, nothing like that.

D: OK. And any autoimmune conditions?

P: No, I don't believe so.

D: No, OK. How about cancers?

P: Uh, no, no cancers in the family.

D: OK, And, and do you smoke?

P: No, I I try to stay away from that with all the running and stuff that I'm doing. I'm uh, I want to make sure that I'm able to to improve.

D: Yeah, for sure. And how about marijuana? Do you consume that in any form?

P: No, I don't.

D: No, OK, and how about recreational drugs?

P: No, I stay away from that stuff too.

D: OK, OK, good. And who do you live with and where do you live right now?

P: So I live with a couple of roommates at school, just finishing up my undergraduate degree.

D: OK, OK. Uhm, have you been in contact with anyone sick recently?

P: No, I don't, I don't think so. Everybody's been been healthy.

D: OK, OK, and travel anywhere?

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

D: OK. OK, uhm, alright, so I think those are all the questions that I have for you. Let's move on to the physical exam part of this interview, if that's OK with you. So I'm going to get you to take a look at both your knees and let me know if you see more redness or swelling in your left knee compared to your right.

P: Uh, no, I'm not noticing any swelling.

D: Do you see any redness?

P: No, no redness.

D: No, OK. How about any atrophy, deformities, or skin changes in your left knee compared to your right knee?

P: No, nothing like that.

D: No, OK. I'm gonna get you to press down and palpate on your quadriceps on both knee. Sorry, on both thighs. Do you feel any pain there?

P: Uh, no pain there.

D: OK, how about when you press down on your knee caps?

P: Yeah, I do get some pain when I push on the on the kneecap, uhm, on my left knee.

D: OK, how about just below that where your shins start?

P: No pain there.

D: No pain there, and then how about on the lateral aspects of your knee?

P: Ah, no pain there.

D: And then the medial aspects of your knee?

P: No pain there.

D: No pain there. OK, good. When you are palpating, was there a difference in temperature between the left and right knee? Was the left knee a little bit more warm than the right knee?

P: No, the temperature feels the same.

D: OK, OK, good. So now I'm going to uhm, are you sitting down?

P: I am yes.

D: OK, so from a sitting position I'm going to get you to stand up uhm, and you let me know if that is painful.

P: It is, yeah.

D: Yeah, OK. Uhm, and then how about when you bend your knees?

P: Uhm, no, no pain with just bending.

D: OK, how about when you, uh, when you flex your hips so you can do one leg at a time, does that hurt?

P: Oh no, that doesn't hurt.

D: OK. And how about squatting down?

P: That does hurt. Yeah, squatting hurts.

D: Squatting hurts OK. OK and then how about when you point your toes towards the ceiling?

P: No pain.

D: OK. How about when you point your toes towards the ground?

P: No pain.

D: No pain. So no pain on dorsiflexion or planter flexion, OK. Do you hear any like popping or crackling sounds in your knees when you climb stairs or when you're standing up after sitting down for a long time?

P: Yeah, yeah, sometimes I will hear, uhm, some, some like yeah, crackling sounds.

D: OK, alright and yeah, you mentioned that you do a lot of running. Do you do any other sorts of exercises?

P: Yeah, I'll do some weight lifting and like cycling as well. I mean, all kinds of different stuff. We just, like staying as active as I can.

D: OK, alright yeah, given your young age and the fact that you do a lot of running and a lot of physical activity like cycling and lifting weights, what you have is most likely something called a Patellofemoral syndrome and that is basically a nerve. Uh kind of pain and then in the in the soft tissues and bone around your kneecap. Uhm, and it's basically happens because of overuse, so vigorous physical activities that put repeated stress on your knees, like running and cycling, uhm, can cause that or just like improper sports training techniques. Uhm, we can do a few things that that'll help with the pain. So for a little bit, if you could hold off on the running that would be good. So, in the meantime, while you while you switch to like low impact activities, whether that's like riding a stationary bike or swimming, you can also try something called the RICE method and so that stands for resting, uhm, so avoiding putting any strain on that knee using ice packs for several days, compression, so wrapping your knee in like an elastic bandage, as well as elevating your knees higher than your, then the level of your chest can help. And then with the sharp pain you could also also take ibuprofen for pain management. Uhm, yeah, so we can start there if it doesn't get better we can also order an x-ray just to rule out other things that could have caused this pain in your knee. And if none of those nonsurgical treatments work, oh sorry, I also forgot to mention will also refer you to physiotherapy to help you with the range of motion and strength and endurance. But of those non surgical treatments work we'll also refer you to like am arthroscopy or some sort of surgery that may be able to fix the issue more permanently. Does that sound OK?

P: It does, yeah, thank you.

D: OK, yeah, no worries.


D: Hi, what brings you to clinic today?

P: Hi, so I feel like I might have a bladder infection. I see a urologist because I've had some issues with like an overactive bladder for awhile. I've had a few bladder infections in the past and this is usually how how they feel. I feel like a little bit of burning when I go to the bathroom and I have to go like a lot right now. But then also sometimes it means that like it gets like this when I have my period and I don't have my period right now, but I you know I I could be getting it, but I also just don't wanna let it go keep going if I do have an infection. I just like rather get it like treated if I do.

D: OK understood. When was your last period?

P: Um, like 2 weeks ago.

D: About two weeks ago, are you fairly regular?

P: Like yes and no, it's. I'm I'm not super irregular, but I I sometimes have like basically it's like I alternate sometimes. I my cycles like 4 weeks and sometimes it's more like 5.

D: Sorry, just clarify again, you're 30 years old?

P: Yeah I'm 30.

D: Ok are you on any contraception right now?

P: Uh, no, I'm not.

D: Ok. Are you sexually active at all?

P: No.

D: No? Ok. So just in terms of your urinary tract infections, when was your last one?

P: I had one like 3 months ago maybe.

D: 3 months ago ok, and they prescribed you antibiotics and it went away fairly quickly?

P: Yeah yeah it went away like I always I always have an overactive bladder and I always have to go pretty frequently, like every hour, sometimes half hour. But so that's still there, but like it hasn't ever since then, I haven't had any like pain with it.

D: Ok, so you still have quite a, you have a, quite a bit of urgency to go?

P: Yeah.

D: Kind of going more frequently, but I suppose the new thing you're a little bit concerned about is that it, it burns a little bit, it stings a little bit when you do urinate. Am I understanding correctly?

P: Exactly like for the past couple days, it's felt like that.

D: Ok, has it been getting progressively worse at all?

P: Um, maybe a little bit I I feel like now I can recognize it pretty early when it's not too bad to kind of get ahead of it.

D: OK understood. And do you have any pain kind of behind your ribs at all? On your back?

P: Sorry, can you repeat that?

D: You haven't had any pain on your back, middle back kind of close to your ribs, have you?

P: Not that I can think of.

D: Ok, and have you noticed any changes to the quality of the urine? For example has it looked frothy or smelled bad?

P: It maybe looked like a little cloudy. But nothing, nothing else out of the ordinary like I've never had blood in it or anything.

D: Understood. Have you noticed any visual changes in the area near the vagina?

P: No, not that I can think of.

D: Like any lesions, anything like that? Anything concerned for an STI that you're worried about?

P: No, and like I haven't had like had a sexual partner in a few years.

D: Understood, understood. These are kind of questions that we ask when someone's having a little bit of maybe an issue holding in their urine. Have you ever felt any numbness or inability to feel kind of around your buttocks region? For example, when you wipe with tissue paper, can you feel that well?

P: Oh yeah, I can feel everything.

D: Ok and no changes to your poops, to your bowel movements?

P: No, nothing, pretty normal.

D: Ok, and how do you feel otherwise?

P: I, I mean, I feel I feel a little tired, felt like a little hot yesterday. I don't have a thermometer so like I didn't take my temperature but, you know, sometimes I feel a little hot like when I've had the infections before.

D: OK, you don't have any swelling on your anywhere in your body on your ankles, do you?

P: No.

D: No? Ok, and then, so no puffiness around your eyes that you've noticed?

P: No, nothing like that.

D: Any rashes or any changes on your face?

P: Like my mom said, I, I I saw my mom earlier and she said I looked like a little flushed but it's not not like a rash or anything.

D: No? No markings across the bridge of your nose and your cheeks?

P: No.

D: Ok, and then in regards otherwise you feel a little flushed, a little tired? Any other medical issues that you have?

P: No, just this like overactive bladder thing.

D: OK, and have they given you any medications for it?

P: We tried a few different ones before, now I get I get Botox injections into the bladder like maybe twice a year.

D: Anything else they've used recently? Like any medications you're on right now, I suppose?

P: No, nothing no nothing else. Yeah, I guess I have like I have an inhaler but I don't use it all the time like I haven't had to.

D: Oh, so you have asthma?

P: Yeah, like I honestly don't feel like I have it very much now, but I still have like I still have the inhaler.

D: Understood, understood. Anything else, you've taken medications for in the past?

P: Oh, I used to take birth control, like the the pill but like I just I don't have a boyfriend right now and I just didn't really feel like I needed it otherwise.

D: Understood, understood. And have you had any past surgeries?

P: Um, I had my appendix out when I was 24. That's it though.

D: Ok got it. And then just in terms of you yourself, do you live in London?

P: Yeah yeah I do.

D: Ok. What do you do for work?

P: I work at a bank.

D: Ok, do you have any children?

P: No.

D: Ok, and in regards to anything so any sick contacts?

P: Uh no.

D: Any recent travel?

P: No.

D: Any allergies?

P: Like sometimes in the spring I'll get like a little stuffy but...

D: Ok, sounds great.

P: No like, yeah...

D: Nothing to concerning? No drug allergies?

P: No, nothing like that.

D: Got it, got it. OK, I think what now do next, I'll move to a physical exam. I think we might just do some investigations just in order to get some more information. And then the physician will come in to see you, ok?

P: Cool, thank you.

D: No problem.


D: What brings you in?

P: Yeah, so I just brought my son, went to the hospital. I've just been getting very concerned because he's making like these, like grunting noises for the last day and, like it's it's really worrying me, I don't know if he's like not breathing and I also just did like a temperature on him just this morning and it came up to like like a high 38, so I don't know what's going on, and then he's just very like irritable and just not himself I think.

D: OK, so all of this started a day ago, you mentioned?

P: Yeah, it started yesterday, but the grunting started today, like, I think he was a bit on the warmer side last night as well, more irritable last night, but the grunting started this morning.

D: OK, Uhm, and you mentioned his fever was 38, correct?

P: Yeah, I think it was like 38, 7 or something like that.

D: OK is he coughing at all?

P: Uhm, yeah, I would say with the grunting there is some coughing in between as well.

D: OK, and is he bringing up any phlegm?

P: Uhm, he's been having some spit ups as well. They're mainly like clear and whitish, but yeah I don't know if he's bringing anything else up. There's no green or yellow material though.

D: OK, any blood in there?

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

D: Does he sound wheezy?

P: Uh no, it's mainly just the grunting.

D: OK, OK, does he look swollen to you?

P: Uh, swollen as in just, uh, like in his.

D: In his, uh, like uh, legs, arms or belly area.

P: No, I don't think so.

D: No ok, and uh, does he have a runny nose or a stuffy nose?

P: No, I don't think so.

D: No, OK, how is his feeding?

P: Yeah, it's it's been difficult. So right now, like his mom is at home, but she was having difficulty feeding. He's mainly breastfed right now.

D: OK.

P: And he's not really been feeding too much either.

D: OK, and how about like the number of wet diapers he has?

P: Just the normal like, that hasn't changed. He has like three or four in a day.

D: OK, OK, good. Have you noticed any changes to his bowel movements or urine?

P: No, pretty much been the same.

D: OK, is he throwing up at all?

P: Nope, just some spit ups, I don't know if that's, Just because of the coughing or if they're just spit ups, like, but nothing after eating.

D: OK, OK, have you noticed any rashes on him?

P: No, no rashes.

D: OK, uhm, has he had any fainting spells or seizures?

P: Uh, no, I've been really trying to make sure, like, I was worried if he gets blue or something that we would rush to the emergency department, but I haven't noticed anything like that.

D: OK, OK good. Has he been in contact with anyone who's been sick recently?

P: No, I don't think so. We've been trying to be very careful with the pandemic and everything going on.

D: For sure, any travel to anywhere recently?

P: No.

D: OK, and is he an other-wise healthy baby?

P: Yeah, so, uh, healthy but he was born premature at 36 weeks.

D: OK.

P: And no complications really with the pregnancy or after he was born. But yeah, he was premature.

D: OK, and so he didn't need any hospitalizations right after birth, right?

P: No, he was fine after birth.

D: And no longstanding medical conditions after birth?

P: No.

D: Has he needed hospitalizations for anything in the past, or surgeries?

P: No, nothing like that.

D: OK, and is he up to date with all his immunizations?

P: Yeah, the two months vaccinations are all up to date.

D: OK, good. Medication-wise is he on anything?

P: No, no medications.

D: OK, any allergies?

P: No.

D: Any family history of lung conditions or heart conditions?

P: No, not that we know of.

D: OK, any cancers in the family?

P: Nope.

D: And who does he live with at home?

P: Just me and my wife.

D: OK, uhm, in a house, apartment?

P: In a house.

D: OK, any old carpets, mold, dust, asbestos, pets, anything like that at home?

P: No, nothing like that.

D: OK, and does anyone at home smoke?

P: Nope.

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

P: Yeah, no, I was just really worried like, the grunting is just really scaring us. So do you, I was just wondering if you know what it could be.

D: Yeah, so the grunting is worrisome. He could have anything from bronchiolitis to pneumonia so what we'll do is, we'll, first get his temperature, we'll get his O2 sat and we will get some imaging done as well to see if it's more in line with bronchiolitis or pneumonia. If it's bronchiolitis, it will be supportive treatment so we can keep him here at the hospital because he is in some distress and we'll keep him hydrated and give him some oxygen. And if it's pneumonia, we'll prescribe him some antibiotics. How does that sound?

P: Yeah, and will he need to stay in the hospital at all?

D: Yeah so for now, because, if he is in any distress and if he needs oxygen, and IV hydration, he'll need to stay in the hospital until he's better from that standpoint. I should also mention, we should do a covid swab on him as well because his symptoms are in line with covid as well, so we'll have to do that to rule it out.

P: OK, yeah, that sounds good, Uh, uh, yeah, thank you so much.

D: Yeah, no worries.


P: I was just bringing my son and he's just had cough for the last couple of days. I thought about a day and a half ago, it doesn't feel like a cold. He hasn't been too sick, but I was a little bit worried and I wanted to get him seen to see if there's anything we could do.

D: Yeah, for sure. It's a good thing that you brought him in. So the cough, is it consistent? Or does it come and go?

P: It seems to be a little bit worse at night. He'll have this cough during the day. Sometimes I'll notice when he's playing. He's had these coughing fits that last for up to a minute but usually recovers from. He hasn't been too active to be honest. He's been a little bit slowed down these last couple of days, but in regards to consistency, I'd say it's a little bit worse at night.

D: OK, any other triggers like dust or the cold air? Anything like that?

P: I haven't really noticed anything. We've been mainly keeping inside due to covid, right? I think my wife left a window open the other night, and maybe the cough was a little bit better. I'm not sure. It's kind of hard to tell when we sleep.

D: Yeah, have you tried anything for it, like have you given him any over the counter cough medications?

P: No, we're a little scared to give him anything. He's so young. He's 2 1/2. We haven't been really giving him any medications to be honest.

D: OK, good. And if you were to describe the quality of this cough, would you say it's barky? Is it harsh?

P: Barky might be a good word to describe it, like he's had colds before his coughs were quiet but this sounds harsh. It sounds like he's really trying to cough hard there. Very violent sometimes.

D: OK OK. And has he ever had a cough like this in the past?

P: No, never.

D: OK, and then in terms of the timeline, is it getting worse? His cough?

P: I think it has been to be honest. He was a little ill like he had a runny nose a couple of days ago, maybe two days ago and then the cough started but it only really started getting noticeably different about the night of the first day, about two days ago so. Now it's been more present I suppose,than it was when he just first had it.

D: OK, and is it a dry cough or does he bring up sputum?

P: Sputum like phlegm,no he doesn't bring anything up really, so dry.

D: OK so no blood as well right?

P: No blood.

D: OK,  does he have any shortness of breath with his cough?

P: I feel like when he has the coughing fits, he's winded. He's weak after them. Sometimes he cries after them or before the middle can be a trigger for it, but just resting normally, he doesn't seem that out of breath, no.

D: OK any wheeziness?

P: No, not really. He's able to breathe. I can't really hear him breathing that much. Sometimes at night after a bad cough he'll be really winded. And yeah, it does sound like a little different when he's breathing, but just right now he sounds normal.

D: OK, and any reason for you to think he has chest pain?

P:  He hasn't any sort of chest pain. He says his throat hurts, but I don't think it's his chest.

D: Has he had any fevers?

P No.

D: Any change in his hair, nails or skin like rashes?

P: No, no rashes.

D: How about weight loss?

P: No weight loss, he's a fairly healthy kid.

D:  And his vision and hearing are normal?

P: You know, I haven't gotten him formally assessed yet, but seems to be able to read pretty well from a distance. He's not in school yet, but I haven't noticed anything, and he can hear fine. I think he responds when I call.

D: OK, has he had a stuffy or runny nose?

P: Yeah yeah, that's kind of how it first started three days ago. Maybe had a runny nose. OK, yeah.

D: Does he still have a runny nose?

P: Umm, a little bit less now. No, not as much now.

D: OK. And his taste, any reason to believe there are any changes there?

P: Well, we've been kind of spoiling him a bit, just giving him ice cream. His throat hurts a little bit and he seems to still like it, so it's hard to tell.

D: OK, so he has a little bit of a sore throat as well?

P: Yeah.

D: OK OK, and then any dizziness or fainting spells that you've noticed?

P: No fainting or dizzy spells, but he's really gassed after he has like a coughing fit and he doesn't want to stand up, he'll just be sitting down or he wants to be held.

D: OK, is he more irritable than usual?

P: Yeah after he has a bad coughing fit, he wants to be soothed and he'll be crying, but it's just more of because he's worn out, I believe he's tired.

D: Yeah, OK, and then any confusion or memory loss?

P: No.

D: OK, and then in terms of his bowel movements, have things been normal from that standpoint?

P: Oh yeah, process of potty training him, but no, no real changes.

D: OK, so no diarrhea, no constipation, no blood in the stool?

P: No.

D:  OK and he's passing gas?

P: OK yeah I'd say so.

D: Any nausea or vomiting?

P: No. We haven't been really feeding him solid meals, it's because he's been sick, we've been trying to give him soup and liquids for the most part because his throat hurts, but he's able to keep them down. So no, no nausea, no vomiting.

D: OK, and then how about changes in his appetite?

P: Yeah, he's not eating as much but still, we're trying to force food into him to keep his energy up. Most of time he always will be asking for snacks in the afternoon, but now not so much.

D: OK. Alright and any anything else that I missed that he's been experiencing over the past few days?

P: No, just the cough.

D: OK, and then he otherwise healthy? Does he have any longstanding medical conditions?

P: No longstanding medical conditions. Yeah, nothing really. We had a little bit of stay in the NICU, just because he was a little bit underweight, but no, nothing really.

D: OK. And then his mother's pregnancy with him? Any complications at that point?

P: Yeah he's a little pre term. 34 weeks I think.

D: OK, was he also underweight too?  You mentioned just a little bit.

P: Yeah.

D: OK, and any complications during the actual delivery?

P: Yeah, not that I remember like she started going to labor early, like earlier than we expected. We thought it was just a regular contraction and that it will just resolve but she wound up proceeding when we showed up at the hospital

D: OK and then in terms of growth, weight and head circumference, has he been hitting all those milestones for the past 2 1/2 years?

P: Yeah, we we bring him to the family doctor every couple of month for his regular checkups and nothing has been brought up to be concerning for his vaccines. He has been doing well.

D: OK and then how about other milestones like speech, movement, fine movement, all of that, like have those been normal? Is he on par with his peers?

P: Yeah, this is our first kid, but compared to his cousins he seems to be doing well. He's speaking, he's got little sentences, now he has good eye contact. He's a good kid.

D: OK, good good. Any hospitalizations or surgeries aside from when he was born?

P: No no.

D: OK good and is he on any medications?

P: No, OK we give him like a flintstone gummy.

D: OK, is he up to date with all his immunizations?

P: Yeah.

D: Any allergies?

P: Not that we know of.

D: Any family history of lung conditions?

P: So my grandfather, so his greatgrandfather I suppose passed away from lung cancer. He was a heavy smoker though. On my mom's side there's some breast cancer. No,  nothing really that comes to mind for lungs.

D: And any heart conditions?

P: No, not that we know of.

D: And how about other cancers?

P: No, not that I know of.

D: OK, how about asthma, eczema or allergies in the family?

P: You know, I think my sister is allergic to peas, but she was never sick from them like go to the hospital.  I don't think there are any allergies in the family.

D: OK, good, has he been in contact with anyone who's been sick recently?

P: You know, like 5 days ago we had a playdate with his cousin. And we kind of thought that that's where he got the cold from. Like the runny nose, but it just turned weird, you know.

D: OK and how's this cousin doing?

P: Last time I talked to Charlotte, Hank seems to be doing well so.

D: Alright, and has he traveled to anywhere recently? Have you any of you traveled anywhere recently?

P: No, with covid and everything, we have just been keeping to ourselves.

D: And with who and where does he live?

P: He lives with me and his mother in a house

D: OK. Any old carpets or mold or concerns for asbestos? Anything like that at home?

P: I don't know when this house is built. I don't think there's any asbestos in it and it's all hardwood. So no.

D: OK, good. Anyone at home smoke?

P: No, no.

D: OK, good. So those were all the questions that I had. Do you have any questions for me?

P: No, no that's it, no.

D: OK, well, from the sounds of it, he most likely has some sort of viral infection. We will do a COVID swap to rule that out because some symptoms do seem to overlap with COVID and we want to make sure to rule that out. So we'll take a swab. Those PCR results should come back in about 24 to 48 hours. In the meantime, he should isolate for 14 days at home and if it's not COVID, it could be another viral infection like parainfluenza, also known as croup. So for that, for any of these viral infections, actually the best treatment is to stay at home and make sure that he's very well hydrated and eating well. If his symptoms persist for three to five days or more, or if his symptoms worsen, especially if he has like a seizure or urological issues, he should go to the ER and if his symptoms do become worse, we can also prescribe him some steroids or epinephrine just to open up his airways. And if it's really, really bad he might be hospitalised as well. So just keep an eye on on that for now. And if you have any
questions or concerns, just give us a call. How does that sound?

P: A little scary. Sounds good. OK, I'll just keep an eye on him for the next five days.

D: Give us a call if his symptoms are becoming worse or if they're not resolving and we will try to do an assessment on him. Of course we will do a physical exam today and will let you know how severe his symptoms are. Most children will get over their infection on their own and he likely won't need any additional treatments.

P: OK, sounds good.

D: Alright take care.

P: Thank you.


D: What brought you in today?

P: Sure, I'm I'm just having a lot of chest pain and and so I thought I should get it checked out.

D: OK, before we start, could you remind me of your gender and age?

P: Sure 39, I'm a male.

D: OK, and so when did this chest pain start?

P: It started last night, but it's becoming sharper.

D: OK, and where is this pain located?

P: It's located on the left side of my chest.

D: OK, and, so how long has it been going on for then if it started last night?

P: So I guess it would be a couple of hours now, maybe like 8.

D: OK. Has it been constant throughout that time, or uh, or changing?

P: I would say it's been pretty constant, yeah.

D: OK, and how would you describe the pain? People will use words sometimes like sharp, burning, achy.

P: I'd say it's pretty sharp, yeah.

D: Sharp OK. Uh, anything that you have done tried since last night that's made the pain better?

P: Um not laying down helps.

D: OK, so do you find laying down makes the pain worse?

P: Yes, definitely.

D: OK, do you find that the pain is radiating anywhere?

P: No.

D: OK, and is there anything else that makes the pain worse besides laying down?

P: Not that I've noticed, no.

D: OK, so not like taking a deep breath or anything like that?

P: Maybe taking a deep breath. Yeah.

D: OK. And when the pain started, could you tell me uh, could you think of anything that you were doing at the time?

P: I mean, I was moving some furniture around, but, that I've done that before.

D: OK, so you didn't feel like you hurt yourself when you were doing that?

P: No.

D: OK, and in regards to how severe the pain is on a scale of 1 to 10, 10 being the worst pain you've ever felt, how severe would you say the pain is?

P: I'd say it's like a seven or eight. It's pretty bad.

D: OK, and with the pain, do you have any other associated symptoms?

P: I feel a little lightheaded and I'm having some trouble breathing.

D: OK. Have you had any loss of consciousness?

P: No.

D: OK. Uh, have you been experiencing any like racing of the heart?

P: Um, a little bit, yeah.

D: OK. And have you been sweaty at all?

P: Just from the from having issues breathing.

D: OK, have you been having issues breathing since the pain started?

P: Yes.

D: OK. Um recently have you had any periods of time where you like have been immobilized or or, you haven't been like able to move around a lot?

P: No no.

D: OK. And have you been feeling sick at all? Any infectious symptoms?

P: No.

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

P: No.

D: Any fevers or chills?

P: No.

D: OK, how about any abdominal pain?

P: No.

D: Any urinary problems?

P: No.

D: Or bowel problems?

P: No.

D: OK, have you had a cough?

P: No.

D: OK. You haven't brought up any blood?

P: No.

D: OK, have you had a wheeze with your difficulty breathing?

P: No, not that I've heard.

D: OK, any changes to the breath sounds at all like any noisy breathing?

P: No. Well, I guess if when I'm really having trouble breathing, yeah.

D: OK. Has anything like this ever happened to you before?

P: No.

D: No, OK. And have you had any night sweats?

P: No.

D: Alright, and then how about any rashes or skin changes?

P: No rashes, but I guess like my neck seems to be a little swollen.

D: OK, do you have any neck pain?

P: No.

D: OK, have you had any like accidents like a car accident or anything where you really jerked your neck?

P: No.

D: OK. Um any any trauma at all to the chest or or back?

P: No.

D: OK, so just in regards to past medical history, do you have any prior medical conditions?

P: No.

D: OK, any recent hospitalizations?

P: No.

D: OK, any prior surgeries?

P: No.

D: OK, do you take any medications regularly? Are they prescribed or over the counter?

P: No.

D: Alright, how about any allergies to medications?

P: None.

D: Alright, any immunizations or are they up to date?

P: They are all up to date.

D: Excellent. Alright, and could you tell me a little bit about your living situation currently?

P: Sure, I live in an apartment by myself. I, uh, yep, that's about it.

D: OK, and how do you support yourself financially?

P: I'm an accountant.

D: OK, sounds like a pretty stressful job or that it can be. Do you smoke cigarettes?

P: I do.

D: OK, and how much do you smoke?

P: I smoke about a pack a day.

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

P: For the past 10 to 15 years.

D: OK, and do you smoke cannabis?

P: Uh sometimes.

D: Uh, how much marijuana would you smoke per per week?

P: Per week, maybe about 5 milligrams. Not that much.

D: OK, and do you use any other recreational drugs like cocaine, crystal, meth, opioids?

P: No.

D: OK. Have you used IV drugs before?

P: No.

D: OK. And do you drink alcohol?

P: I do.

D: OK. How much alcohol do you drink each week?

P: Uhm about I would say I have like one or two drinks a day, so about 10 drinks a week.

D: OK, uh, yeah and um alright, and then briefly, could you tell me a little bit about your like diet and exercise?

P: Sure, I try to eat healthy for dinner at least, but most of my lunches are, uh I eat out. And then in terms of exercise, I try to exercise every other day, I run for about half an hour.

D; OK, well that's great that you've been working on the the activity and the diet as well. So has anything like this happened in your family before?

P: No.

D: OK, has anybody in the family had a heart attack before?

P: Actually, yes, my father had a heart attack when he was 45.

D: OK, and anybody in the family have cholesterol problems?

P: I think my father did.

D: I see OK, and how about anybody in the family have a stroke?

P: No strokes.

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

P: No.

D: OK, and is there anything else that you wanted to tell me about today that that I on on history?

P: No, I don't think so. I think you asked me everything.


D: What took, brought you in today?

P: Yeah, I'm just feeling, so, I do have COPD, but I just feel so much worse. I do have shortness of breath, but I think it's just been worse over the past three days. I'm having more difficulty climbing stairs, or even just going to the bathroom.

D: OK, and you said this started?

P: Three days ago, three or four days ago.

D: And since that time has the shortness of breath been getting worse or staying the same?

P: Yeah, so initially it was just, it was just climbing stairs, you know, but then after that, I mean, this morning, I was just short of breath going to the bathroom.

D: OK, and have you had, uh, shortness of breath on exertion like this before?

P: Uhm, you know, sometimes.

D: OK.

P: I don't, do much anyway, because my CPD, you know, just makes things a little bit difficult, uh, yeah, I use my puffers.

D: OK, and have you had any, uh, episodes where you've woken up in the middle of the night and were really short of breath, you had to, uh, sit up?

P: No, no, no.

D: OK, and are you able to lie flat?

P: Yes.

D: OK, and you mentioned you were bringing up sputum. Could you describe the color?

P: Yeah, I don't know it's kinda yellow, uh, green.

D: Has that changed from before?

P: Yeah, yeah, so usually it's just sort of whiteish and foamy, and uh, yeah it's different. And it's more, you know, it's alot more, every time I'm coughing it's just like, spoonfuls, it's a lot more than usual.

D: OK, yeah, it sounds like a lot more and have you noticed any blood?

P: No, no, no.

D: OK, and uh, so have you had a cough then?

P: Oh yeah, I've had a cough for the past 20 years.

D: OK, and is your cough worse at any particular time of the day, Or does it happen throughout the day?

P: Well, it's a bit worse when I'm smoking, but otherwise it's the same.

D: OK, and has your cough been worse these past couple of days as well?

P: No.

D: OK, and have you had any headaches?

P: No.

D: How about any ear pain or eye pain?

P: No.

D: Any sore throat?

P: No.

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

P: No, I don't think so.

D: OK, and have you had any wheezing?

P: A little bit. It's been there for a while though.

D: OK, have you noticed any changes to the wheeze?

P: No, I don't think so. I don't know. I can't tell.

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

P: No.

D: Have you had any lightheadedness or dizziness?

P: No.

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

P: No.

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

P: No.

D: Alright, and any urinary problems?

P: No.

D: Any bowel problems?

P: No.

D: OK, and have you had any changes to your skin or any rashes?

P: No, not really.

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

P: I think I was feeling very chilly last night. My wife had to bring an extra blanket for me.

D: OK, have you had any night sweats?

P: No, I don't think so.

D: OK, and uh, have you checked your temperature?

P: No, I didn't.

D: OK, we'll certainly check that today. And have you had any weight loss in the last several months?

P: I don't check my weight very often, but no, uh, yeah, my clothes still fit, they're all, they're fine.

D: OK, fair enough and, uh, have you noticed any, like, leg swelling or any swelling in your belly?

P: No.

D: OK, and in regards to your past health, you mentioned COPD, but have you been diagnosed with any other medical conditions?

P: Yeah I have high blood pressure, and my cholesterol is also a little bit on the high side.

D: I see, OK and you use puffers. Do you use any other medications?

P: Yeah, I think my doc prescribed some pills, I don't know, I don't remember what they are, I just take them every day.

D: OK, we can get that information. Have you had any hospitalizations?

P: Uhm, I've been to the ER a couple of times and this one time, it was similar to this time, when I was having difficulties breathing and had to stay for about five days or so. I think that was two years ago.

D: OK, and how are your symptoms feeling now when compared to, uh, that time?

P: I wasn't producing this green yellow thing that's coming out of my mouth right now. It was not that bad. It's just last time I was having difficulties breathing, so I decided to come in. But this time I just have this weird thing, I don't even feel like looking at it.

D: OK, yeah, for sure it sounds like there's something certainly going on here and Yeah, have you had any past surgeries?

P: I had, uh, I had a knee replacement.

D: OK, and, uh, can you tell me a little bit about your living situation, like who do you live with and whereabouts?

P: Yeah, I live with my wife about ten minutes away from here. We live in an apartment, uh, yeah.

D: OK, are you working, are you retired?

P: I retired two years ago. I used to work at Chrysler, as a mechanic.

D: OK, and have you been around anybody who might be sick?

P: No.

D: Alright, how about, have you traveled anywhere?

P: No, I've just been staying indoors. My wife's been staying with me. We're both pretty careful, we're worried about catching covid so we don't even go out for groceries, we just have those delivery guys come and bring us our groceries.

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

P: I smoke about a pack a day.

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

P: Let's see, about forty-five years.

D: OK, have you thought about quitting?

P: Yeah, yeah, multiple doctors have told me to quit and it's just, I don't think I can quit. It's not gonna happen. I can't live without my cigarettes.

D: OK, the door is always open and certainly something we can talk about at anytime, uh, if you'd like to, but, uh, in the meantime, we'll leave it alone for now. I was wondering if you drink alcohol?

P: I drink a glass or two every weekend.

D: OK, and do use any other recreational drugs like marijuana, cocaine?

P: No.

D: OK, and, any family history of heart or lung conditions?

P: Uhm, high blood pressure.

D: OK, has anybody in the family had lung cancer?

P: No.

D: Alright, and, so you've been experiencing worsening sputum production that now has a green color to it, and now having a bit more, more short of breath, which sounds like COPD exacerbation, especially since it's a similar type of presentation as before. And so we'll order a chest X-ray, some blood gases and do a sputum culture and possibly start antibiotics, but, depending on the severity we may not not need to just yet. And then we'll also use some inhalers as well as inhaled steroid to help with the inflammation in the airways.

P: Sure.

D: Alright, we'll get that started.

P: Thank you.


D: I heard that you've been having, uh, some difficulty breathing and you've been coughing. Can you tell a little, tell me a little bit more about that.

P: Yeah, so uh a couple of days ago. I just started to not feel so well and I've been having this cough and trouble breathing.

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

P: I do have a, uh, cough regularly, but I mean, I, I think that's related to maybe smoking. It's something that was going on for a few years. This coughs a little bit different.

D: OK, in what way is this different?

P: It's been happening more often throughout the day and. And bringing up more more mucus, it seems like.

D: OK, and then you said it start started a couple days ago, is that correct?

P: Yeah, I think like Monday, so, uh, yeah I guess like 3 days ago then.

D: OK, and since you noticed it has it gotten worse over those three days.

P: Yeah, I would say uh today's the worst day I've continually felt um sick.

D: OK. And how frequently are you coughing?

P: Uh I would say maybe a couple of times per hour. I'm I'm filling up a some tissues with sputum.

D: And what does that? What does that sputum look like?

P: It's like a dark greenish yellow colour.

D: OK. OK, um and. Is there anything that you've changed recently in your life or any kind of things that have provoked your cough that you know of?

P: Ugh, no, I can't think of anything. I've been kind of sticking to my regular routines.

D: OK, and is there anything that makes, uh, makes it worse, say any position or anything that you do in your day to day routine you find makes you cough more?

P: Um And not really I can't. I can't think of anything.

D: OK. And, have you taken any any medicine or anything to try to help with us?

P: Um. No, I I've I I do have a little bit of pain so I was. I did take some Tylenol and some Advil over the last few days, but that's about it.

D: OK, Ok. Did you find that they helped at all?

P: A little bit yeah, but it would just kind of take the edge off of the pain for a little bit and it came back.

D: And what kind of pain is it that you're experiencing?

P: Um, it's kind of a a sharp pain over on the like the right side of my chest like maybe belly area.

D: OK, OK um the right side of your chest and belly area. Yeah OK, so is that pain, is it, did it start around the same time as the cough?

P: Yeah, I think it, it might have started a little bit after.

D: OK, and is this a pain that you've ever had before?

P: No, I haven't had anything like this happen before.

D: OK. Is the pain primarily there when you cough or is it present at all times?

P: I would say more so when I cough or if I'm like taking a big breath. Um yeah, kind of after after I have a coughing episode I take a deep breath and I really will feel the pain then.

D: OK, and and um, you said that it's a sharp pain?

P: Yeah, yeah, more of a sharp pain.

D: OK, OK, and is it any worse when you're doing activity, like when you're up and walking around?

P: No, don't notice it with any any activity.

D: OK. OK, um an since uh, since this coughing and this this right sided pain that you're talking about began, have you noticed any fevers?

P: I think, yeah, I've been hot the last few days and I I checked my temperature earlier today and it was like 38.6 so that was one of the reasons why I wanted to come in actually.

D: OK. OK, well I'm glad that I'm really glad that you came in because yeah, we really want to get this looked into. Have you been around anyone that's been sick recently?

P: No, but I I do some volunteer work at one of the homeless shelters at a few times a week, so I am around a lot of people.

D: OK. And have you traveled anywhere recently?

P: No, I've been at home. And and doing the volunteer work.

D: OK um. OK, and can you just give me an idea of any? Do you have any chronic conditions that you see your family doctor for regularly or anything you take medication for?

P: Um yeah, I have type 2 diabetes. And I I take Metformin. Um I think an SGLT 2 inhibitor and then I use insulin for that as well. And I have some, it has affected my kidneys as well. The diabetes I mean.

D: OK, do you have a history of high blood pressure?

P: I do yes.

D: OK, do you take medication for that?

P: Oh yeah, I do. It starts with an "a" I think, amlodipine.

D: OK OK and do you have any history of heart problems?

P: No, not that I know. No, I haven't really had any chest pain. On the left side anyway.

D: Um, So you said that you have had a cough for a really long time, a dryer cough then you're having sputum now. But is that something you've seen the doctor for?

P: Oh yeah, I think I was called like bronchitis in the past or something. Something like that. One of the doctors, my family doctor told me it was because I was a smoker.

D: OK. So just to make sure I have your list of medications, you take amlodipine, insulin
metformin, and an SG LT2 inhibitor? You think anything else?

P: Um, and then yeah, amlodipine, uh, yeah, I think that that that's everything. Oh a multivitamin too.

D: OK cool. I just wanted to ask you a few questions questions about your lifestyle in general. Do you live here in town?

P: I do. Yeah, I live with my wife and at a house nearby.

D: OK, cool and you mentioned that you're a smoker?

P: Yeah, so I've smoked for the last 30 years or so. About a pack per day.

D: OK, do you drink alcohol?

P: No, I don't.

D: Do you use any other substance?

P: I don't, no.

D: Ok. And do you have any family history of respiratory or heart problems?

P: Yeah, my dad actually had a heart attack. He was in his 70s. I think my mom had high blood pressure, but other than that, no.

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

P: I think just environmental stuff, no medications. I am aware of.

D: OK, OK. Well thank you for sharing all of that with me. I'm going to go over it with the physician that I'm working with and will kind of come back and let you know about the next steps.

P: OK, thank you, that sounds good.


D: How can I help you today?

P: Hi um, I'm bringing my one year old daughter in because she's had this fever um, this runny nose and this cough, for the past three, four days. Um, and now, she sounds pretty wheezy.

D: Okay, and um, as she had a fever the entire time over the past three or four days.

P: Yeah, I would say so like it's come and gone, but every time I checked her temperature, I tried to check her twice a day, it would be pretty high, like 38 or uh, 39.

D: Okay, so it was between 38 and 39 each time you checked it.

P: Yeah, and now I should mention like um, I checked today and she didn't have a fever today, but she sounds really wheezy now.

D: Okay, is the wheeze new today?

P: Uh yeah.

D: Okay, um, and the cough, that started about three or four days ago as well?

P: Yeah, that's right.

D: And how, how does the cough sound? Does it sound like, barky or like a, seal-like cough?

P: Um, it sounds pretty harsh. I don't know if it sounds barky.

D: Okay, and is the cough worse at any particular time of the day, like morning or night?

P: Uh no it's, it's just always there.

D: Okay, uh, is she bringing up any, any phlegm or sputum?

P: Um, she's bringing up some, um, she's, she actually, she used to bring up some phlegm, but now it's, it's pretty dry.

D: Okay, um, so she was bringing up phlegm initially and is no longer. What colour was it?

P: It was clear.

D: Okay, any blood that you noticed there?

P: Uh, no, no blood.

D: Okay, um, and yeah, she's, she's had a wheeze as well. Um, have you noticed, uh, any chest pain, if she's like pointing to her chest or anything?

P: No, nothing like that.

D: Okay, and has she had any, any like fainting spells?

P: No.

D: Okay. Um, and, yeah so she's had a fever, has she had any like, chills or night sweats, like where she's shaking?

P: Oh no, no.

D: And how has her mood been?

P: She's been pretty fussy, um, yeah, she's been pretty fussy over the past few days, but I just thought it was because of how she was feeling um, like her symptoms.

D: Yeah, certainly. Has she been eating and drinking okay?

P: Yeah, we've managed to get her to drink and eat okay. Um, so, in that sense, no changes there.

D: Okay, how many diapers is she, how many wet diapers per day?

P: Uh, about five.

D: Okay, so yeah, still been to maintain hydration, it sounds like. Um, yeah, okay, and has she had any like, eye redness or eye discharge?

P: Uh no, nothing like that.

D: Any suggestion that she might have um, like any ear pain or, or any ear discharge?

P: No.

D: Okay, and has she had a runny nose?

P: Um yeah, now that you mention it, yeah, she did have a runny nose. Um, it seems to be less now, but she did have a lot a few days ago.

D: Okay, and did that start around the same time as the cough and, and fever?

P: Yeah.

D: Okay, um, it's still going on, but, but just less.

P: That's right, yeah.

D: Okay. On feeds or anything like that, did you notice like any redness in her, in the back of her throat?

P: Um, I noticed some, um, yeah, I noticed some redness, but I just thought it was because of her coughing a lot.

D: Okay, um, and um, have you noticed any skin changes or, or rashes?

P: No.

D: Alright, and any changes to bowel habits like diarrhea?

P: Uh no, no changes there.

D: Okay. Then any changes to um, like urinary habits as well?

P: Uh no, no changes there.

D: Okay, and have you noticed any like bulging on her, on her forehead or on the anterior fontanelle?

P: No.

D: Okay. Um, and uh, has she had any nausea or vomiting?

P: No, not that I've noticed.

D: Alright. Um just yeah, she's been a little bit more, um, irritable as well. Um, okay, and has she had any symptoms like this before?

P: I mean, when she was a few months old she had similar symptoms, um, and she was like hospitalized for maybe a day or two, but she became better.

D: Okay, did she need like antibiotics or inhalers or anything like that?

P: I think they just gave her some oxygen and then um, some fluids.

D: Okay. Um, has she been diagnosed with any medical conditions before?

P: No.

D: Okay, and besides that one time going, like going to the hospital, has she been hospitalized or had any surgeries?

P: Uh no, before that she was fine.

D: Alright, uh, are the immunizations up to date?

P: Yeah, everything's up to date.

D: Excellent. Um, and in terms of the pregnancy itself, were there any complications throughout um, with mom?

P: Uh, no, no, no complications.

D: Okay. And was it a full term delivery, and vaginal or c-section?

P: It was uh, full time and it was vaginal.

D: Okay, any concerns at birth, like jaundice or, or any types of distress?

P: Uh no, nothing like that.

D: And how is her growth and development been thus far? Any concerns?

P: No.

D: Okay, um, that's great, and in terms of um, the home environment, who's living with her and um, who's primarily looking after her?

P: Um, so it's her dad and I, as well as her um, her grandma.

D: Okay, and has anybody in the home been sick recently?

P: No, everyone's been healthy.

D: Okay, um, and has there been any travel?

P: Um no, we haven't gone anywhere recently.

D: Okay, um, and does anybody uh, in the house smoke?

P: Uh, nope.

D: Okay, and are there, are there any pets or are there any like carpets or um, linens that can hold, hold a lot of dust or dander?

P: No.

D: Okay, any other exposures, to like triggers, or potentially things that, that could be exposed or stuff like, that could be inhaled?

P: No, I don't have anything like that at home. It's a fairly new home and uh, it's hardwood floors, yeah.

D: Okay. Um, and uh, any family history of lung problems or heart problems?

P: No, no.

D: Okay, how about a family history of any congenital diseases or um, any genetic diseases?

P: No, nothing like that.

D: Okay, um, and family history of any cancer?

P: No.

D: Okay. Um, so were there any other um, so that was everything that I wanted to ask today before I went on to the physical exam. Um, was there anything else that you, that you wanted to add or were wondering about that I maybe forgot to ask?

P: Yeah um, what, what can we do for her um, to make her better? And are you concerned about her breathing?

D: Um, so the, the physical exam and the, the vital signs will really, will help with um, to assess her breathing and to see oxygen levels.

P: Yeah.

D: Um, and um, this could be uh, caused by um, a viral infection, which could be something along the lines of uh, like a common cold type picture, and we can get like inflammation of uh, really small airways, um, and it can cause that cough, and fever, and some of the symptoms that she's experiencing. And also, um, these symptoms do overlap with COVID as well, um, and so it'll be important to get a COVID swab just in case. Um, but um, if that is the, the scenario, then it will be um, supportive care with oxygen, fluids and we'll make sure that um, that her, her breathing is uh, okay. And possibly, we'll need steroids and um, and uh, an inhaler if necessary.

P: Okay. Okay, that sounds good, thank you.


D: So I understand you removed insects from your leg earlier today?

P: Yes I did, it was uh it was behind my left uh knee kind of in like the joint behind where it bends. Um it was stuck pretty good, it's still kind of red and tender there. I noticed it because the back of my knee was starting to just feel a bit sore, um not the joint itself, but just kind of the skin, the whole area back there. Um and I found this tick, I brought I brought it in with me if you wanted to have a look at it, um it's in like this little plastic container, uh and I don't really know when I got it. I was hiking on Friday um and then Saturday I was out in my garden, I hope they're not around my house, I hope that it was from hiking um and not gardening, but uh I did spend a lot of time outside on Saturday as well.

D: OK, so sounds like it's been a little bit of time since you were last outdoors to when you first noticed it?

P: Yeah.

D: OK, so when you picked it off the tick, obviously you have it for me, is it quite swollen or engorged?

P: It's not too bad, um I I have actually had a tick in the past and this is a long time ago and um maybe like 10 years and I actually had that kind of target rash thing that they talk about. And, uh at that time I remember I had to take antibiotics for a bit. Um this um didn't look like that, it was more, it was just kind of sore in one spot, I don't think it um it was as bad as that time and the tick that time, sorry I've kind of gotten off track, that time it was quite swollen, this one was maybe a little bit, but not as much.

D: OK, so just in terms of the tick's size, it doesn't look like it's been feeding for too long, so when ticks uh are feeding they tend to engorge, they tend to swell up, so this looks more like a tiny little bug or does it kind of look like a little grape, almost like it's been swollen up with blood?

P: No, this one, this one's pretty small.

D: This one's pretty small, OK. And I should mention that, well obviously you've had a tick bite in the past, the big concern for us is a disease called Lyme disease, which is spread by bacteria, but in fact only one type of tick predominantly is a transmission transmitory agent for it. It's called a deer tick, and its coloration, it's got a little bit of a brown butt and there's some black legs. Does it look like that at all?

P: I don't think so, uhm, I uh I was looking at the pictures online, I think it looks like the other kind of tick, um but I heard that, yeah, but I heard that lately now they've been considering all ticks in this area as possibly carriers of Lyme um because I think it's kind of become more more of a problem sm so that was making me a bit nervous.

D: OK, absolutely, what we can do is we can send this tick off to the lab and they'll be able to identify the species for it, but for tick bites in general, one of the key considerations is for how long it's been on your body for. So unfortunately, if you're out on Friday and Saturday, that'd mean that this tick has been on you for longer than at least 72 hours. So I think one way or another, we're likely going to have to put you on antibiotics just as kind of a prophylactic at the very least, just want to make sure that um you're not at risk of developing Lyme disease. I'm sure you've heard from the news that Lyme disease can present in a variety of ways, but it's a disease that we try our best to avoid. And just in terms of your symptoms, so you say you've had a bite in the past and you you've got that rash before, that kind of bullseye rash, do you have that rash now?

P: No, I don't uh as far as I know, I mean, you can have a look too. It's behind my knee, so it's not the easiest place to see, but it's uh it looks a little red, it's like tender where the tick was, but I don't see that like larger circle rash.

D: OK, that's reassuring. Now any, it'd be pretty unlikely for you to have other symptoms, but just in case, do you have any other joint pain?

P: No.

D: Have you been feeling ill or have been feverish in the last little while?

P: No, no, I've been fine.

D: OK, and you removed that twit tick once you found it, you presented to me, have you checked your body for any other possible bites?

P: Oh yeah, I looked around and I looked at my husband too 'cause we we were just a little bit, you know, gave us a little bit of a scare, but no, there's been nothing else.

D: That's good. And did you bring a pet with you at all when you were hiking and gardening?

P: Uh no, I didn't, no.

D: OK, good. Any other family members you think might have been exposed?

P: Uh no it was just uh me and my husband.

D: OK, and what geographic area were you in um when you were hiking?

P: We were uh in Strathroy along the creek.

D: OK. I can do, if I remember there's a Lyme disease distribution map for Ontario and we can see exactly how that lines up to see if we should be a little bit concerned or not. Looks like Strathroy is close enough to be considered a little bit of a concerning point, so I think that we will be moving forward with antibiotics, but of course we'll be talking to the physician who'll be having a look at you as well. So it sounds like you haven't been having too much symptoms aside from you've noticed this tick, the skin around it is fairly sore and you've had this in the past, but you were treated with antibiotics in the past and since then you haven't had too many health problems after that?

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

D: OK, and just about your health right now, is there anything that you see the family physician or doctor for in general and regarding your health?

P: Uh just for my cholesterol.

D: OK, are you taking and medications for that?

P: Uh Yeah, I take a uh statin, can't remember which one.

D: OK, got it. And do you have any allergies?

P: Uh no.

D: So no drug allergies?

P: No.

D: OK, now we've already talked about other exposures, so it doesn't sound like anyone else in your family or any pets are around, so it's unlikely that you have ticks coming in and you said you might have gotten this from gardening, but um you're hoping that your area doesn't have ticks. Maybe just take a look, ticks like to live in long grass, kind of on the intersection between woods and fields to see if there's any hovering around that kind of make a waving motion with their legs and they're sometimes easy to spot, you might wanna get some insecticide out there. But it sounds like this is fairly recent, unfortunately just for the length of time this tick might be on you for, it's probably safer than not to start you on some medications, but I'm going to go talk to the doctor after we do a quick physical exam, and we might also send the tick off to a local laboratory so they can identify the species for it definitively, as well as might just send some blood work just to see if there's any titres or any serology that would make us a little bit more concerned for Lyme disease. But aside from that you've been feeling well otherwise?

P: Yeah, totally fine. It was just a little tender there and that's the only reason I looked.

D: OK. So no headaches?

P: No.

D: Nothing like that?

P: Nothing like that.

D: OK, excellent, alright. I'm fairly happy with what we talked about today. Do you have any questions for me Jean?

P: No, this is pretty well what I expected today, so thanks for helping me out.

D: No problem. OK, I'll go talk to the doctor, we'll come back and talk to you, OK?

P: Great, thanks.

D: Thanks Jean.


D: How may I help you today?

P: I've been having, uhh, like, nasal congestion and I've been sneezing a lot, over these last couple of days, and I've also been having a sore throat.

D: Oh no, when did that start?

P: So the store throat started like 2 days ago.

D: OK, and since then you've developed this nasal congestion and sneezing as well?

P: Yeah exactly, it started a bit afterwards or around the same time.

D: Yeah, alright and have you have any other symptoms? Do you have a fever?

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

D: OK, do you have any difficulties swallowing?

P: Uh, Yeah, it has been a bit sore when eating food, but it hasn't been so painful to prevent me from eating.

D: OK, do you have a cough?

P: No, I haven't had a cough.

D: OK, uhm, and do you have a runny nose, any discharge?

P: Uh, Yeah, there's been a little bit of a like watery discharge, my nose has been running.

D: Any ear pain or any pain in your cheeks or your head when you're bending over, anything like that?

P: Uh, yeah, now that you say it, yeah, when I was bending over to put my shoes on, I felt just a bit of pressure on the front of my face.

D: OK, and you haven't been feeling feverish or having having any chills, right?

P: No

D: OK, any fatigue, malaise, any aches or pains?

P: Uh. no, I felt OK, that way, yeah.

D: Any rashes?

P: Uh, no.

D: No, OK, Have you been up to date with your immunizations?

P: I have yes.

D: Alright, and just have a couple more questions just to see if anything else is going on. Do you have a headache at all?

P: Uh, yeah, I've had a headache, since this morning. It's pretty mild. It feels like my head is squeezing. I think, uh, I've had headaches like this before, if I don't sleep well or dehydrated.

D: Are you more stressed out than usual? Do you have exams or anything going on right now?

P: No, schools been pretty good. We've been doing a lot of stuff online, so uh, yeah that's been good.

D: OK, any, uh, do you find that your eyes are runny or red or anything like that?

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

D: OK, alright and any difficulties breathing?

P: No.

D: Any chest pain?

P: No chest pain.

D: Ok, any pain in your belly or any problems with your bowel movements?

P: No

D: OK, any urinary symptoms?

P: No

D: OK, alright good. So can you tell me if you have any medical conditions?

P: Uh, no, I had dermatitis when I was a kid but I haven't had any issues since. I remember using some creams for that but I haven't needed to use them recently.

D: OK, and any medications that you're taking currently, including over the counter pills?

P: I don't take anything currently.

D: OK, did you take any medications, to reduce the symptoms that you're having, the headache or the sore throat?

P: Oh sorry, yeah I used some Advil this morning. I think it was 400 milligrams.

D: OK and do you have any allergies?

P: Um, yeah, to cats.

D: Have you been around a cat recently?

P: No, we used to have a cat, but unfortunately we were unable to keep it because allergies were so bad.

D: Yeah, do you have any environmental allergies at all?

P: Uhm, yeah sometimes in the spring or fall I can get like itchy eyes and a runny nose, so that's why I didn't think much about the runny nose at first, but with a sore throat and, been sneezing more, I thought to come in.

D: Yeah, OK. So in terms of your, uh, so general information. Do you live alone or do you live with your parents or anyone else?

P: Yeah, I live with my mom, dad and a younger brother.

D: Alright, and are you currently working or going to school?

P: Yeah, I'm finishing up Grade 8 and we're doing the courses online.

D: OK, great so, have you spent any time outdoors or spent any time with people who you think might be sick?

P: Well, I've played some, like, basketball outside with one of the neighbors, but I don't think he's been sick.

D: OK, alright, and have you traveled anywhere recently?

P: No, I've been at home.

D: OK, uhm, alright, and do you, uhm, have you had these symptoms anytime recently before?

P: No, not that I can think of.

D: No, have you been tested for covid anytime in the recent past?

P: No, I haven't.

D: Have you taken any antibiotics recently?

P: No.

D: OK, alright well it sounds like you're probably having just a common cold, likely viral. So, and seeing that it's only been two days, have your symptoms gotten better or worse in the past couple of days?

P: They've gotten worse since it's started.

D: Yeah, OK, well, it's only been two days so far, let's just keep an eye on your symptoms and see how you're doing. It might also be a good idea just to get a covid swab done, and if your symptoms continue to worsen, give me a call again and we can talk about it a little bit more and see if maybe a bacterial infection or if there's something else that's going on. You don't have any difficulties breathing, do you?

P: No, I don't.

D: Alright, OK, alright umm, we'll do a physical exam and then chat a little bit more after.

P: OK, thank you.


D: How are you doing today?

P: I'm doing OK, I just had this cough that's really started to bug me.

D: OK, thanks for coming into the emergency Department today. We will really try to get this sorted out for you. How long is this cough been going on for?

P: Um about five days 5 days.

D: Ok 5 days, and has anything else come on during that time? Are you having any other symptoms?

P: Yeah, I've been feeling pretty pretty hot and just haven't been really feeling very good. Overall, I've been just exhausted.

D: Oh Im sad to hear that. Have you ever had anything like this before?

P: Yeah, maybe when I was younger, I don't know when I had the flu or something like that.

D: OK. OK, so I'll ask you few more questions about your cough. So it started 5 days ago, has it gotten any worse or better since then?

P: It's been getting worse for sure. It's like going all all throughout the day, and it's been even interrupting sleep.

D: Oh, geez. That's too bad. Do you find that it, does it feel really dry or are you bringing up like gunky stuff?

P: It it's really dry.

D: OK. And he is there anything that seems to make it worse or better?

P: Not really, it's pretty consistent throughout the day.

D: OK. OK, um have you had any chest pain?

P: Yeah, after coughing it can, it's it's starting to hurt, it didn't at first, but now that I've I think I've coughed so much it's starting to feel pain there.

D: OK, what what part specifically in your chest are you feeling pain in?

P: Uh actually now that I think about of it, it's more more in my throat actually with the cough.. I would say with the cough. Yeah yeah, more of the throat.

D: Would you say you have you've had a sore throat?

P: Yeah I guess so yeah I would, like now with the cough that's really kind of what I mean by what's been bugging me.

D: OK OK, thanks for sharing that with me. Um and, along with this, have you noticed any change in your sense of smell or taste?

P: Um yeah, my smell is definitely been off ahh, which is kind of weird. My taste has been fine though.

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

P: Yeah, now that you say it, I mean, well I guess this morning.

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

P: Uh, no, nothing like that.

D: OK. Um and you said you felt really hot. Have you taken your temperature at all?

P: No, I haven't, that's why, but I've been feeling pretty sweaty so that that's where I I feel like I have a fever, so I wanted to come in.

D: OK, OK. Have you lost any weight recently, like unintentionally?

P: No, I've actually put on probably 5 or 10 pounds.

D: OK. OK um. Have you had felt any any chills, or shakes?

P: Mmmm nothing like that.

D: OK. Have you had any night sweats?

P: Um yeah, actually like yeah last night my shirt was was soaked through when I when I got up.

D: Oh no. OK, and was that just last night?

P: Yeah yeah that was just last night.

D: OK. OK um. So I'm just going to ask you some questions or sorry few more questions on this and then we'll move on to just your health in general. Have you traveled anywhere recently?

P: Um, no. I've been been well, just going to work an an home.

D: OK. Um, have you been in contact with anyone that might be sick?

P: Um it's well, it's hard to say at the grocery store. I guess I see a lot of customers that come through, but um. I generally things are wiped down pretty frequently so.

D: So you work at the grocery store?

P: Yeah.

D: OK, and do you live alone or with family?

P: Alright, yeah, I live with family I I live with my wife and two children.

D: Oh nice, yeah, do they work out of the home? Have they been in contact with anyone that's been sick?

P: Well, they're in high school um, and they've actually been doing a lot of their coursework on online, so. Yeah, I haven't really been around to any other other people.

D: And your wife?

P: Yeah, she's been she's been home as well.

D: OK. So in terms your overall health do you, are there any conditions that you see your family doctor for regularly?

P: Yeah, so I have a high blood pressure and type 2 diabetes.

D: OK.

P: And so I I take a Ramipril and Metformin.

D: OK, Ramipril and Metformin, any other medications?

P: Umm vitamin D.

D: OK, and have you ever had any surgeries?

P: Um, yeah I had my Gallbladder taken out about 10 years ago or so.

D: OK. OK um. So do you have any allergies?

P: Ahh just too like environmental stuff like um pollen I think.

D: OK. OK, so not any allergies to any medications?

P: No.

D: OK um. OK, do you have any family history of respiratory problems?

P: Um, I think, um, my brother has asthma. And I think my mom has asthma too.

D: OK. Um OK, and in terms of your lifestyle, that sounds like you live with your wife and kids, you work at a grocery store. On a weekly basis, do you do you drink alcohol?

P: Maybe I'll have like 3 or 4 beers on the weekend.

D: OK, so three to four drinks per week?

P: Yeah, about that.

D: Do you smoke?

P: No, I do not.

D: Do you use cannabis or any other substances?

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

D: OK, OK, well I think that just about covers the things that I wanted to ask you today so. Based on the symptoms you're experiencing. It sounds like it could be some kind of infective process, like maybe some kind of viral infection that we're concerned about, particularly this year. I'd really like to get a swab done on you. It's not necessarily covid, but it potentially could be. So what we're going to have to ask you to do is to self isolate you and your family for 14 days and hopefully will get the results back shortly and you'll know whether your COVID test is positive or not.

P: OK.

D: Does that sound like a good plan to you?

P: Yeah, that sounds good.

D: OK well thanks for chatting with me. We will get that swab done right away.

P: Thank you.


D: What brings you here today?

P: Yeah, so I'm bringing my um daughter because uh over these last uh several months she's had this uh this cough that that comes on, um it'll be at night time or sometimes uh after, in gym class. Um and I know during these episodes she'll have a really hard time, kind of catching her breath and and sometimes will have a wheeze as well and and it's just gone away quickly in the past but been noticing it happening more often recently.

D: OK, so it's been going on for the last few months, but it's kind of getting worse?

P: Yeah, exactly yeah.

D: And how about the the coughing and the wheezing and the, does she have any kind of shortness of breath?

P: Um yeah she will like when it comes on, uh yeah she she has some shortness of breath.

D: OK, and um does this happen at all, like when she's exposed to dust or kind of after exerting herself?

P: Yeah it does. Yeah I think the like the first time that um that I was made aware of it was yeah in in gym class so it would've been after some exercise. Um and, dust, uh, I'm I'm not sure.

D: OK. Um does she have a dry cough or wet cough when she gets these spells?

P: Uh dry.

D: Dry, OK. Um did she bring up any sputum or blood at all?

P: No.

D: OK and are her symptoms at all constant, or do they come and go based on how much she's exerting herself?

P: They come and go. Yeah, like most of the time she's been OK, but uh, and sometimes she'll get a cough at night time too.

D: OK. Um so, and then has, does anything make, help you with your symptoms at all, or her symptoms?

P: Uh, um not really no.

D: OK.

P: Just resting I guess, sorry yeah, just just trying to relax.

D: OK, and any other symptoms like fevers or chills or sore throat, chest pain, anything like that?

P: No, nothing like that, um yeah, just the wheeze.

D: OK, any loss of her sense of taste or smell?

P: No.

D: OK, um any recent travel?

P: Uh no.

D: Um any contact with anyone who's been sick recently?

P: Uh she has a, uh, a younger brother that goes to daycare. Uh and I know um those kids can be sick all the time, but um her brother's been OK.

D: OK. Um does she complain of any kind of headaches or uh nausea or vomiting?

P: No, she doesn't.

D: OK. Um any, have you noticed any fevers or chills?

P: No.

D: OK, um any night sweats?

P: No.

D: OK. Um any changes in her bowel movements like constipation or diarrhea?

P: Nope, she hasn't had any change, changes like that.

D: OK, and any kind of uh changes in her sleep or appetite?

P: No, she's been eating well and and gaining weight.

D: OK, um any, uh so she's been gaining weight um, any exposure to any mold, dust, um new rugs or animals at home?

P: Yeah, we do have um 2 cats at home.

D: OK.

P: Yeah, there are animals at home.

D: OK, how long have you had them?

P: Um for for about um yeah, just under a year. So yeah, just under a year.

D: OK um, has she been diagnosed at all with any medical conditions in the past?

P: Um, no, no, and when she was born she had to uh go in the, just be observed for a few um a couple of days for jaundice. She didn't need to have any therapy for it, it went away on its own, but that's about it.

D: OK, and any um complications during the pregnancy with her?

P: No, everything was was normal and it was a vaginal delivery at at term.

D: OK, um any issues with the development, uh is she meeting her milestones in her growth, um meeting her milestones on her growth chart as well?

P: Yeah, all of that has been has been normal.

D: OK, um any allergies to medications or environmental factors that you know of?

P: Not to um any medications that I'm aware of, but um she hasn't been tested, but she does get symptoms that uh kind of change with um seasons, like she'll get a runny nose and some itchy eyes um at different times throughout the year.

D: OK. Um any medications that she has been on at all?

P: So when that happens we just use um like she'll just take a uh like Reactine or like I don't know something like that, but just an allergy pill, um but it's yeah, that's it.

D: OK, um and any hospitalizations or past surgeries?

P: No, luckily she's been healthy that way.

D: OK, um any family history of any lung or heart conditions?

P: I think uh yeah, yeah her grandfather has diabetes, but um that's it.

D: OK, uh, and currently what's her home situation like? Who does she live with?

P: Yeah, so she lives with um myself and uh her father and then younger younger brother. That's it, yeah, that's four.

D: OK. Um OK, and does anyone smoke in the household?

P: Um no, they don't.

D: OK. Um OK, so those were all the questions I had. Um do you have any questions?

P: Uh, no, I just uh yeah just wanted to figure out what's going on with this cough.

D: OK, yeah, so it seems like the symptoms have been going on for a few months now. It seems that she gets them on exertion and um they're worsened by exertion. Um at this age, one thing that definitely we want to check is if she has asthma. Um she does have some other symptoms that um are associated with asthma, like it seems that she gets um, some irritation through environmental factors as well. So what we'll do uh for her is get something called a pulmonary function test for her to see, that'll test if she in fact has asthma or not, and then based on that we will uh see if she needs any puffers. Um that can help relieve some of her symptoms. Uh and lastly, since she's having a cough, we'll also do a like a Covid test just in case as well.

P: OK, yeah that that sounds good. Thank you.

D: Yeah, and no worries, and then we'll also do like a full physical examination.

P: That sounds great.

D: Alright.