D: What brings you here today?

P: Yeah hi, I've had this cough, um, for the past four days and it just can't, it won't go away. So, I was just wondering if, you know, I can get something for it.

D: Okay, so uh, so you've been having the cough for four days. Can you describe the cough a little bit? Is it like a dry cough or wet cough?

P: Uh, it's dry.

D: It's dry, okay. Um, are you coughing up blood at all?

P: No, no blood.

D: Okay, are you bringing up any, although you're not coughing, are you bringing up any kind of sputum?

P: No, no, it's, it's pretty, it's pretty dry.

D: Okay. Um, and any other symptoms at all, besides the cough?

P: No, nothing else.

D: Okay, and have you been sick at all recently with fever, chills, runny nose, um any cold like symptoms?

P: Um, you know, a week back I had a runny nose. Um, and sometimes like a stuffy nose, but that went away.

D: Okay. Um, and after that, did you have any fevers at all?

P: No.

D: Okay, and has this happened to you before at all? Like a cough lasting more than four days?

P: Yeah, it's happened to me in the past. Um, yeah it, yeah it has. Um, but it's just more bothersome this time cause I'm coughing a lot more.

D: Okay, and is there anything that you've tried that has helped you relieve the cough at all?

P: I tried some over-the-counter cough suppressants. Uh, they don't seem to be working too well.

D: I see, and anything that's making your cough worse at all? No?

P: No.

D: Do you have any other symptoms, like a sore throat, runny nose, headache, anything like that?

P: No, nothing like that.

D: Okay. Have you been around anyone that's sick recently?

P: No.

D: No. Um, have you had any, um have you traveled at all outside of the province or country at all recently?

P: Nope, not outside the province.

D: Okay, and other than that, are you having any symptoms of, kind of, muscle aches uh, or anything like that?

P: Uh no, no muscle aches. Um, nothing else that I can think of.

D: Okay, any shortness of breath?

P: No, no shortness of breath.

D: Is the cough like constant, goes on throughout the day, or is there a time that it's worse?

P: Uh, it's pretty, it's pretty constant.

D: Okay. And do you have any kind of um increased tired, like getting more tired or fatigued?

P: Um, no.

D: Um, any kind of chest pain or feeling that your heart is racing?

P: Um no, nothing like that.

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

P: No.

D: Okay, any um nausea or vomiting?

P: Um nope, nothing like that.

D: Okay, um, any kind of uh, changes in your sleep or appetite?

P: Uh, no.

D: And um, have you lost any significant weight recently?

P: No.

D: No, okay. Um, otherwise, are you healthy? Do you have any medical conditions at all?

P: Uh, no I don't, I'm otherwise healthy.

D: Otherwise healthy, okay. Any allergies to any medications?

P: No.

D: Any allergies to any environmental, or any environmental factors?

P: No.

D: Okay. Um, any family history of any medical conditions related to the heart, lungs, any cancers at all?

P: Uh no, nothing like that.

D: Okay, alright. Um, are you, so, what, what is your living situation like right now?

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

D: Okay. Um, and are you working at all or are you a student seeming?

P: Um, I work part time. I work as a barista.

D: Okay, and anyone, anyone in your work environment, or uh in your home environment, or at school that has been sick around you?

P: Not that I've heard of, no.

D: Okay. Um, and other than that, do you smoke at all?

P: Um, no I, well, I used to smoke before. I stopped last year.

D: Last year, okay. And how long did you smoke for?

P: I smoked just a couple, like two years.

D: Okay, yeah. So congratulations, that's a really great thing to do, especially like right now, with the pandemic going on and everything it's, earlier you stop, it's really good.

P: Thank you.

D: Besides uh, like smoking, um do you use any recreational drugs like marijuana?

P: No.

D: No, okay. And how about alcohol?

P: Nope, I don't drink too much alcohol. I drink like over the Holidays.

D: Okay. And I forgot to ask you this earlier, but any hospitalization or surgeries in the past?

P: No, nothing like that.

D: Nothing like that, okay. Those are all the questions, um, I have for you. Do you have any questions or concerns?

P: Um, yeah, what should I do about this cough?

D: Yeah, so this cough, um, it's been going on for the last four days. Since you do have a cough, um and right now that, like, is considered a symptom, like, like a potential symptom for COVID, we definitely want to do a COVID swab test for you, which will come back in 24 hours to 48 hours. You should still try and isolate as much as you can away from any roommates, or family members for the next, so, 14 days since you first experienced the, the cough.

P: Okay.

D: Based on, like, public health will call you as well so you can follow their instructions. And if, it can be anything else too, like, with a cough, there can be multiple things going on. You can have um, like an upper respiratory, viral, or bacterial infection. But since you're not having too many other symptoms right now, it can just be bronchitis. Um, this is something that we'll try and keep an eye on and make sure it's nothing else like, uh pneumonia, for example. But right now, yeah, we'll get that testing done and then just, kind of wait and watch.

P: Sure, yeah. Thank you.

D: You're welcome, take care.

P: You too.


D: Um, what brings you in today?

P: Uh yeah, hi, I just came in here today cause uh, lately, for the last couple of months, I've been getting these coughing fits. They don't really seem to be going away and I was a bit concerned.

D: So you've had this, when did this start?

P: Uh, I would say probably during the winter uh it, it kind of started, where I started having um, just coughing fits when I'm walking to school and then also during like gym class I started having these coughing fits and sometimes I also felt like I couldn't breathe.

D: Um, okay. Okay, what did you, is there anything, so it's basically worse when you're um, doing some sort of an exercise such as walking um, or being in the gym class, and it's also worse in the cold?

P: Yeah. Yeah, and then also like, I remember when I was walking down the street and someone was smoking and then I just completely just started having that episode right after I walked past them.

D: Okay um, alright. Uh um okay, sorry, one moment. Okay um, so is there anything that makes your cough better? What do you do to make it go away?

P: Uh, I just basically have to, if I, if I'm doing any kind of activities, just take a moment, sit down for like 10 to 15 minutes and then it seems like it goes away on its own.

D: And you said that sometimes you also have difficulties breathing with it?

P: Yeah, like a couple of times it got really bad where I had to um like, it was difficult get, it was, it was like I was trying to take deep breaths for air, but uh it was, it just felt like I couldn't.

D: I see. So this started a couple of months ago, has this ever happened to you before that?

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

D: Okay, and so I'm going to ask you about a couple other symptoms. Let me know if you've experienced any of these in the past couple of months. Um, so have you had a headache that accompanies the cough?

P: Uh no.

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

P: No.

D: Any confusion?

P: No.

D: Um any, um, runny nose or stuffy nose or sinus congestion?

P: Uh no, not really.

D: Okay, any sore throat?

P: Uh no.

D: Any um, chest pain?

P: Um, sometimes when I get like really bad coughing fits, like it sometimes starts hurting in my chest as well.

D: Yeah. Um, does it go away when you stop coughing?

P: Yeah, it goes away after, I just take some rest.

D: Um, have you had any belly pain?

P: Uh no, not at all.

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

P: Uh, no.

D: Any changes in your, any nausea or vomiting?

P: No.

D: Any changes in your bowel movements?

P: No.

D: Any acid reflux?

P: Uh, no.

D: Okay, um, and any certain muscle aches or joint pains?

P: Um no, nothing like that.

D: Any numbness or tingling in your arms or legs?

P: No.

D: Okay, let's get back. Okay, great, it sounds like that the, the cough is sort of the main symptom here that you have. Um, is the cough dry or wet?

P: It's usually uh, it's usually dry.

D: Uh sorry, can you say that again?

P: It's usually dry.

D: Okay um, have you ever brought up any sputum or any blood?

P: Uh never any blood, I have like on occasion, like sometimes brought up some sputum.

D: Okay, alright. Um okay, and, uh, have you been vaccinated?

P: Uh, yeah, all my immunizations are up to date.

D: Okay, good good good. Um, does the cough sound like a barky cough or a muffled cough, or um, does it have a specific characteristic? Does it sound different than when you're sort of coughing to clear your throat, for instance?

P: Uh yeah, it's like pretty, it can get pretty harsh. I also noticed like uh, there's like this weird noise I started making like right after when I'm trying to take deep breaths in.

D: Okay, okay. Okay, so you're wheezing. Okay, so you ever um, cough so much that you end up vomiting?

P: No, no that hasn't happen yet.

D: Um, and do you, so you mentioned that it's worse when you're in the cold or exercising, and smoking makes it worse? What about things like dust or pollen? Um, say when you're cleaning the house and there's also dust, does that make things worse, or is it worse in a specific time of the year when you're outdoors?

P: Uh, now that you mention it, yeah, like if we're ever in the basement or anything like that, I, I do start getting like kind of irritation um, in my throat, and that kind of, sometimes I have also coughed at those times.

D: Alright. Uh, can you tell me, okay so, can you tell me if you have any medical conditions that you've been diagnosed with?

P: No, nothing else, I've been pretty healthy.

D: Okay. Had, did, when you were a child, did you have any sort of rash? Did you have eczema?

P: Oh I, yeah, so I did I, at one point I was using like this cream um, probably when I was ten. Just for some eczema on my hands.

D: Okay. And um, have you ever had allergic rhinitis, which is basically sort of having um, red or teary eyes, itchiness on the face, a runny nose at certain times of the year, or in um, areas with mold or dust, or termites and things like that? Have you had anything like that as a child or right now?

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

D: Okay. Alright, uh do you have any, um, I guess going back, were you a healthy child, growing up?

P: Yeah, as far as I know, I, I didn't really have any concerns from like the school or home at all.

D: Okay, that's great. Do you uh, did you ever have any hospitalizations?

P: No.

D: Any surgeries?

P: No.

D: Are you taking any medications?

P: Uh, no medications.

D: Are you still using the eczema cream?

P: No, no. That kind of just went away on its own, or like right after I used the cream. Like it's good now.

D: Okay, good. Are you allergic to anything?

P: No, I don't think so. Maybe just like environmental allergies sometimes, in the springtime.

D: What happens then?

P: Um, just sometimes like uh, I don't know if it's like a pollen allergy like I, I do get some, I guess I do get like some nasal congestion and things like that.

D: Um, have you ever seen an allergist?

P: No, I haven't.

D: No. Uh, who prescribed the cream for the eczema?

P: Um, just a, it was like at a walk-in clinic.

D: Okay, okay. Um alright, and do you have any family history of any um, lung-related problems? Or any other problems?

P: Um, my older sister has asthma, and uh, I don't know if anyone else in the family has asthma. Um, I think my father has high blood pressure.

D: Alright, and you mentioned that things are going well at school. Um, who do you live with at home?

P: Yeah so I live with my older sister, and my mom and dad.

D: Okay, okay. And things are good at home? Do you feel safe?

P: Yeah, yeah, I feel completely safe.

D: Any concerns about bullying at school?

P: No, no, not at all.

D: Okay are you uh, are you taking any marijuana or any street drugs?

P: No, no, my parents would kill me.

D: What about alcohol?

P: Uh, I'll come, I've, I haven't tried it um, yet, at all.

D: Okay, okay. Just wanted to mention that the conversation that we're having right now is confidential between you and me. Um, unless you mentioned anything that harms you or harms anyone else so, so feel free to discuss whatever or talk openly about um, any issues that you have. Um, okay, and um, are you sexually active?

P: No, no.

D: Alright, okay. So um, that's all the information I needed. Uh given that you've had these coughing fits for the past couple of months that are, that have certain triggers, uh, and also given that you've had a history of eczema, and your sister has asthma, so kind of, sort of runs in your family in a way. You might also have a diagnosis of asthma potentially. Um, and so, what I would recommend is that you get um, testing done and um, uh I guess before I sort of talk a little more about this, I just want to get a sense of how severe your asthma, if it's asthma at all, um if, does it, does it affect your ability to, you said school was going okay, does it affect your ability to do well at school at all?

P: Um definitely in, in gym class, but other than that it hasn't really affected me.

D: Does it wake you up at night?

P: No, so far no. I, I like, I get pretty good sleep.

D: Okay, okay. Um, and how often, I guess is, do these episodes occur? How many times a week, or how many times a month?

P: Uh, so they just started like two months ago, and I've had like maybe four or five of them in total.

D: Okay, okay. Uh, and they kind of get better on their own. Okay, so we can sort of talk about these, sorry, puffers that you might need to, to use as needed. Um, your sister might have some of those, so you might be familiar with what I'm talking about.

P: Yeah.

D: Um, so we can talk about that. Um, given that your symptoms are, yes, they've been occurring for the past couple of months, but because you have had a cough, it might be a good idea just to have a COVID test done once. Um, I don't think that's what you have, seeing that this, these symptoms have been lasting for, have been occurring for the past two months, so we'll just kind of do that test to rule it out. Um, in the meantime, I would recommend that you um, try this inhaled corticosteroid puffer that you can use, that you should use on a daily basis, and try to avoid uh, the triggers. So the things that you, that cause these symptoms. Um, we can go over how to use uh, a puffer properly and I will also give you a spacer, which will help deliver most of that medication in the, uh, to your lungs. Do you have any questions?

P: Uh no, I don't have any questions at all. Thank you so much.


D: What brings you in to see us?

P: So I've just been having this cough that I feel has just been getting worse, and I've also been feeling a bit short of breath for the last few months.

D: OK, could you tell me when the cough started?

P: So I would say it started around two months ago.

D: OK, and has the cough been dry or have you been bringing up sputum?

P: Uh, it's usually always, uh, produces like the sputum, and it's usually white or yellowish in colour.

D: OK, and how much sputum are you producing each day? Some, sometimes it's useful to think about like teaspoons or tablespoons.

P: I would say every time I cough like a teaspoon I probably have like. I don't know. Maybe 5 to 10 teaspoons a day.

D: Uh OK, and is there any particular time of day that the cough is worse?

P: Um, not really. It's pretty, pretty much the same. Sometimes it is worse in the morning. Yeah, and sometimes it gets better when I go out for a smoke.

D: OK um. And have you noticed any blood?

P: No, um I haven't noticed any blood.

D: OK, and have you had, so you had shortness of breath, when did that start?

P: It's around two months ago, around the same time.

D: OK, And. Is this? Do you have shortness of breath at rest or is it when you exert yourself?

P: Uh, it's it can happen like at anytime, but worse when I am exerting myself.

D: OK and then have you had a cough before?

P: Uh. Not as frequently. I would say not really, it just started in the last two to three months.

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

P: Just throughout my life I've had asthma so when I am exercising too much or get exposed to like dust, sometimes get shortness of breath.

D: OK. Has there been anything, um besides exerting yourself, that's made that either the cough or or shortness of breath worse?

P: Uh, over the last year like I've had a couple of chest infections. After going to the ER, they gave me some antibiotics. But yeah, when that happens it usually gets worse. The shortness of breath and the cough.

D: OK, and uh, do your symptoms feel like any of those times right now?

P: No, I I don't feel like I have a fever and no other symptoms, just the shortness of breath and cough.

D: OK, and have you been doing anything that's made it better?

P: I've been taking some Tylenol Cold, hasn't really helped too much. I've tried my inhalers, they sometimes help, but I've never had have this frequent of coughing and shortness of breath before.

D: OK, um, and how has your energy been? Have you been experiencing fatigue?

P: Um, when it gets really bad then I can't really step out of the house, but other than that I feel like my energy's still there.

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

P: No.

D: OK, how about at a loss of smell?

P: No.

D: Um a loss of taste?

P: Nope.

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

P: No, just sometimes when I'm like coughing a lot it gets a little bit uncomfortable. But other than that, no.

D: OK, um have you had any instances where you felt like your heart was racing?

P: No.

D: OK, how about being lightheaded or or like you were going to pass out?

P: No.

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

P: Nope.

D: OK, and how about headaches?

P: No headaches.

D: Alright, and have you had any wheezing?

P: Um, sometimes I've noticed it, but I had it before. Like with asthma as well, but not not that much.

D: OK, and how about abdominal pain?

P: No abdominal pain.

D: Alright, then any urinary problems?

P: Nope.

D: Any bowel problems?

P: No.

D: Any rashes?

P: Nope.

D: OK, and then how about any muscle aches or or joint aches or or body aches?

P: No, nothing like that.

D: Alright. And you mentioned asthma, but have you been diagnosed with any other medical conditions?

P: No, just asthma.

D: OK, and do you use inhalers? Are there any other medications you're currently using?

P: Oh no, just the salbutamol and like the steroid inhaler.

D: OK, yeah, and how often are you using both of those?

P: So the steroid one I am using pretty much every day but the salbutamol I found I've been using a lot more recently. I would say probably at least six to 10 times in a week.

D: OK, um that reminded me I I forgot to ask. Have you notice any changes to your voice?

P: Um no, not really.

D: OK um. And I was wondering if you had any allergies to medications?

P: No, not that I know of.

D: Alright, and have you been in the hospital recently?

P: No.

D: Alright, so when was the last time that you had antibiotics?

P: I would say like six months ago.

D: OK and any surgeries?

P: Nope.

D: OK, and did you get the flu shot this year?

P: Yep.

D: OK, great um and I was wondering if you could tell me a little bit about your living situation.

P: So I live in London um in a small apartment with my wife.

D: OK, do you have any pets around?

P: No, no pets.

D: Alright, and um, any exposures at work too, like dust or any types of like chemicals like that.

P: No, not really. My work is pretty much a desk job, so nothing like that.

D: OK, and do you smoke cigarettes?

P: Yeah yeah, I smoke a lot of cigarettes just like I would say 30 cigarettes a day.

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

P: I'd say, probably at least 25 years.

D: OK and sorry, could you remind me of your your age again?

P: So I am 60 years old now.

D: OK, so you started smoking um around 35.

P: Yeah yeah.

D: OK. Have you tried to quit?

P: Yeah, tried to quit. I've even quite a couple times but then just got back onto it. Yeah, not not really ready to quit.

D: OK. That's fair enough. If there's something that you wanted to talk about quitting smoking at another appointment, we can arrange follow up for that.

P: Alright

D: Do you drink alcohol?

P: Not much, just out say one or two beers on the weekend.

D: Alright, and you use any recreational drugs like cocaine, crystal meth, or IV drugs.

P: No, nothing like that.

D: Alright, and has anything similar like this happened in your family before?

P: Uh, I think my um sister has a COPD, like she smokes a lot too. But that's that's about, I don't know if that's genetic.

D: Oh OK, um I. So I mean anybody in the family have cancers?

P: Um no, not that I know of.

D: Alright um so, that that was all the questions that I wanted to ask on history. Was there any, uh, any other questions that you had?

P: No, not really. Just wanted to get to the bottom of this.

D: OK for sure so um we will run some investigations and likely get a chest X Ray because it's been a couple of months that these symptoms have been going on for. But I think it could be related to your smoking and most likely um Bronc, chronic bronchitis, but we can definitely will be looking into this, and then also with possibly some pulmonary function tests as well.

P: OK, sounds good.


D: So what brings you into the family clinic today?

P: Yeah, I've had this sore throat for the past three days and it doesn't seem to be getting any better at all. I feel sort of feverish so. I just thought I should come in and get this checked out.

D: OK, and when did you start having this sore throat?

P: Three days ago.

D: OK, and how about the fever?

P: The fever I noticed maybe a day back.

D: OK, and did you get any temperature measurements?

P: I didn't take any myself. But I felt hot, and I felt chills.

D: OK, and have your sore throat or fever gone worse at all?

P: I think it's getting worse, yeah.

D: And does it usually happen during the day, throughout the night or does it have any sort of pattern?

P: I would say that it doesn't really have a pattern. The sore throat is always there and the fever started a day back and it seems to break sometimes, but right now there is no real pattern to it.

D: OK. And besides that, do you have any cough?

P: No, no cough.

D: OK, and have you tried anything that has helped you at all?

P: I tried just like those Lozenges and seems to be helping just soothe my throat, but it's a temporary relief.

D: OK. And have you had anything like this happen to you before?

P: No, nothing like this.

D: And is the sore throat constant? Or does it come and go?

P: I would say it's pretty constant now.

D: OK. And have you been around anyone that has been sick recently?

P: Not that I know of.

D: Anything that makes your sore throat worse?

P: I guess swallowing foods makes it worse, or at least it's painful.

D: OK. And have you at all noticed any like swelling around your neck region, like swelling of your lymph nodes?

P: So yeah, not swelling of my entire neck, but I have felt some lumps in my neck.

D: OK, and how about any swelling anywhere else on your body?

P: Nowhere else.

D: OK, have you noticed any kind of skin changes like rashes or anything like that?

P: No.

D: OK. And have you traveled at all recently?

P: No, nowhere.

D: OK, do you have any headaches or nausea or vomiting?

P: No, nothing like that.

D: OK, and any night sweats.

P: No.

D: And do you feel fatigued like increased tiredness at all?

P: Umm, yeah, I've been feeling really tired.

D: OK, any chest pain or feeling that your heart is racing?

P: No, nothing like that.

D: OK. Any issues with bowel movements, like any diarrhea or constipation?

P No, no, that's been normal.

D: OK, any changes in your urination?

P: No, no changes.

D: Have you been getting sleep at night or do you have to keep waking up?

P: Um, I've been getting OK, I sleep like, I've been sleeping about 7 to 8 hours.

D: OK. And how about your appetite?

P: I would say that's been OK as well, it's just hard to eat a lot of food because of this sore throat.

D: And is it just with solids or do you get the soreness with liquids too?

P: I would say mostly with solids, sometimes with liquid. If it's like really cold or something.

D: OK. Do you have any kind of allergies to anything in your house like carpets, pets or anything like that?

P: No.

D: OK, have you had any recent infections like a cold?

P: No.

D: No, OK. And do you have any past medical conditions?

P: Um, I have Crohn's disease.

D: And when did you get diagnosed with Crohn's?

P: That would have been last year.

D: Last year, OK. And are you taking any medications for your Crohn's disease?

P: I am on something for it, I think it's Sulfasalazine or something like that.

D: OK. And any other medications besides that?

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

D: Any previous hospitalizations or surgeries?

P: Um, I had a colonoscopy done. I just needed hospitalization for just the day I guess.

D: OK, and when was that?

P: That was also last year.

D: Last year, OK. And do you have any family history of any conditions that run in the family? Like do you have any Crohn's disease or Ulcerative Colitis that run in the family?

P: Yeah, both do.

D: Both do, OK. Any anything else that runs in the family?

P: Uhm, I know there's some asthma and eczema that run in the family too.

D: OK. And you mentioned you haven't been around anyone that was sick or recently got sick?

P: No.

D: OK. And where do you currently live?

P: I live in an apartment by myself. Sorry, not by myself, with my parents and my younger brother.

D: And do you at all drink alcohol?

P: No, I drank once or twice in the past, but I didn't like it. It makes my Crohn's worse so I stay away from it.

D: OK, and do you smoke cigarettes?

P: No.

D: And how about any other drugs like marijuana?

P: No.

D: OK. Alright, so do you partake in any like sports or activities or anything like that?

P: Um, I swim.

D: OK, any contact sports?

P: No.

D: OK. Alright, so yeah, overall it seems that you had this sore throat which is constant, getting worse and a bit of a fever in th last one or two days and you've also had swelling in your neck and so yeah, do you have any other questions or concerns?

P: No, like what do you think I have? Do you think it's COVID?

D: Yeah, so definitely at this time, you know whenever people have any respiratory symptoms we always want to rule out COVID.  So will definitely get a swab for COVID testing done for you today which should come back within 24 to 48 hours and in the meantime you should self isolate. And other than that, it can also be, due to this swelling in your lymph nodes and also just the other symptoms, it can be other viral infections. It can be mono so we definitely have to do a couple of tests, and there's one test that will do for mono as well which is called EBV antibody testing. So we'll do a couple of these tests today and then see what what comes back. And in the meantime you should definitely self isolate if you haven't been doing so already.

P: OK, sure I can do that.

D: Yeah, do you have any questions?

P: No, that sounds good. Thank you so much.

D: You're welcome. Take care.

P: You too.


D: What brings you in?

P: Um I just uh I have, I have a cough that I've had for a couple of days and like normally if I had a cough or cold, I would just like stay home and rest, but just because you know there's like Covid I I wanted to make sure, like I wanted to get checked out.

D: Yeah, of course that that was a great idea. Thanks for coming in. Um how long have you had this cough for?

P: Uh it's like 2 days. Like maybe three days ago, I started to feel like my throat was dry and I was like, oh, maybe I need to drink more water or something and then the next day I started like actually coughing.

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

P: Yeah it's really dry.

D: Really dry, OK. So no sputum, no blood that you're bringing up?

P: No, nothing like that. It's just kind of annoying.

D: Yeah, um do you have any wheeziness associated with your coughing?

P: I don't think so.

D: No, OK. No shortness of breath?

P: No, no, I've been, I feel like I've been tired, but I don't think it's been actually hard to breathe. I just feel overall like really tired.

D: OK, OK, and have you tried anything for the cough, like um over the counter cough syrup or anything like that?

P: Uh like I have, I've just been drinking tea and just like tea with honey just to like make it feel better. I I didn't like take any medicine.

D: OK, and do you, have you noticed that there are any triggers for your cough, like the cold, or dust, or any like environmental triggers?

P: I mean, I've been, just because of Covid and stuff, I've been staying home ever since I had it.
Uh so, I don't, I can't think of anything, but I don't think so.

D: OK, and do you find that it's constantly there or um is it worse during a particular time of day, like morning, afternoon, or evening?

P: It's kind of just been there
all the time right now.

D: OK, and um is it getting worse, do you think?

P: I think so. I think like today is worse than yesterday, and the day before that, it just felt like dry and then and then like the next day I started coughing, so yeah.

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

P: I mean, I've had coughs before, um this one feels like particularly dry, but uh like it, it's not too different than like when I'm just like, like had a cough in other years.

D: OK, OK. Um and you mentioned that your throat was also dry. Do you have a sore throat?

P: Maybe a little bit this morning, yeah, like at first it just felt dry like I was thinking like, oh it's like you know I need to take a sip of water or something and now it just feels, now it's starting to think, I feel a little bit sore, I think.

D: OK, um is it hard for you to swallow foods or fluids?

P: Oh sorry, could you repeat that? I just missed the last part.

D: Oh no worries. Is it hard for you to swallow food or fluids?

P: Uh no, it's not hard. It's not hard to swallow things.

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

P: No, not particularly.

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

P: No.

D: No, how about changes in smell or taste?

P: Uh, no, that's like a Covid thing, right? Like I was hoping because I could still, I could still like taste my coffee this morning, I was hoping that that means I don't have Covid, but yeah, I don't really know.

D: I mean yeah, some people have it, some people don't. Um I guess people with Covid present in different ways, yeah yeah, do you have a fever at all?

P: Um like when I came in here, when the nurse took my temperature, she said I had um, like she said I had a fever. Uh I don't have a thermometer at home, um but like I've been feeling really hot so would probably, I've probably been having it for a couple of days.

D: OK, OK, we can take, yeah we can take your temperature. Sorry, did you say you already took your temperature today and?

P: The nurse took it, yeah, I don't know what it was, but the nurse kept coming in and she said it was a
little high like I don't know if it was like a fever but I've been feeling hot, so.

D: OK OK yeah so yeah we'll double check to make sure that um you either do or don't have a fever. Um have you experienced any chills or night sweats over the past few days?

P: Uh, no.

D: No, OK. OK, how about um any weight loss?

P: No, like I don't weigh myself regularly, but I don't think so.

D: OK, um any changes to your hair or uh nails or skin, like rashes?

P: Uh no.

D: No, OK. How about um chest pain?

P: Uh, no.

D: No chest pain, OK. Um swelling in your limbs?

P: Uh, no.

D: No, do you ever feel like your heart's racing?

P: Uh, no.

D: No, OK. Um how about um, how about any dizziness or or fainting spells?

P: Um, no, like I've been just tired.

D: Just tired, OK.

P: Yeah I don't, I don't, I haven't fainted or anything.

D: OK, any headaches?

P: No.

D: No, OK. Uh how about confusion or memory loss?

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

D: OK, um any changes to your bowel habits?

P: Um, no.

D: No, OK. So no constipation or diarrhea or blood in your stool?

P: Yeah, exactly.

D: OK, any changes to your urine?

P: No.

D: OK. Any nausea or vomiting?

P: No.

D: No, OK. And um no abdominal aches?

P: No.

D: No, OK. Um are you otherwise healthy?

P: Um like I have um, I have uh Like some um Like digestive problems generally, like I haven't had any changes to that, but they think it might be like Crohn's or something. Um but other than that, no.

D: Um you said you had digestive problems. Did you say it might be Crohn's?

P: Yeah, like I, I've been seeing my family doctor and they they said they thought it might be, um but we don't really know, just like in general, I guess they've been calling it IBS.

D: Oh, I see, OK. Um, OK.

P: I wish I knew exactly, but they just said, yeah, they don't really know.

D: OK.

P: But there haven't been any changes right now.

D: Oh yeah, I see, OK. Um have you ever had any hospitalizations or surgeries?

P: No.

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

P: No.

D: OK, and how about um any allergies?

P: Um, just uh pineapple, like not any medications or anything.

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

P: Uh yeah yeah.

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

P: Um, like my my uncle had a heart attack.

D: OK.

P: I don't, like, not my parents.

D: OK, I see. Um any cancers in the family?

P: Uh, no.

D: OK. Um and do you smoke?

P: No.

D: No, OK. How about marijuana?

P: No.

D: No, OK, um any other recreational drugs?

P: Um no, no

D: OK, how about alcohol?

P: Uh, like I drink, I don't know maybe I'll drink like a bottle of wine on like a weekend, like over a whole weekend or something so like, I don't know maybe like 3 or 4 drinks over the weekend.

D: Three or four drinks a weekend, OK.

P: Yeah, something like that.

D: Sure, OK.

P: I'm not at all like.

D: OK, so occasionally?

P: Yeah.

D: OK. And where do you live?

P: Uh I live in town here.

D: OK, do you live in a house, in an apartment?

P: Um my fiancé and I live in a townhouse.

D: In a townhouse, OK, um, any um concerns for like old carpets or mold or asbestos, anything like that?

P: Uh no, it's like a new a new building.

D: OK, OK, and do you think you may have been in contact with anyone who's been sick recently?

P: Well, so um, I work uh in like, I work in an office that's attached to a factory um and I, so like I have to actually be there, I haven't been able to work from home. Um and there was someone else in my office that I think was coughing in that, like last week and I I don't know, I questioned it but I I didn't actually get to talk to them and ask them, or like I don't know if they were actually sick or something. So, I might have been, and we wear masks and everything, like we're really good, but I don't know, I feel like the offices aren't like super, like the air flow's not that great.

D: Yeah.

P: So yeah, I think that's another reason I was concerned, that I I feel like some people might have been sick and I didn't really know the whole story.

D: Right, OK, so potentially, from from the workplace then, OK.

P: Yeah.

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

P: No.

D: No, OK. Well those were all the questions that I had for you today, was there um anything that I missed that you wanted to discuss today?

P: Uh not that I can think of.

D: No, OK. So right now it seems like, if I'm going through my differential diagnosis list for you, at the top is, the thing that we have to rule out is Covid, so we'll take a swab and send it off for those PCR results and you'll hear back either tomorrow or the day after, about the results. But in the mean time, and I guess even if the test is negative, um and you're still having symptoms, please do isolate for 14 days. Um and if your symptoms get worse, um like you know, you're having trouble breathing, uh your fever, your temperature is off the charts, um or you're having any sort of neurological symptom, please do um go to the ER and seek out help. Um if it's not Covid, it could be another viral illness that's going around at, during this time of year, um, and usually the treatment for that kind of stuff is supportive, so make sure you're staying well hydrated, you're eating nutritious foods, uh you're getting good sleep. Um and if not, and your symptoms, you know you're having a productive cough, um you're really short of breath, uh we can test you to see if you have some sort of bacterial pneumonia, and those are usually treated with antibiotics, so that's kind of the plan right now. Um so we'll just start with that Covid swab for now. How does that sound?

P: Yeah, that that sounds great. That's really what it, like, I I don't feel super sick, I just really wanna know if I have Covid or not.

D: Yeah for sure and I, and I think it's good that you came in.

P: Awesome.

D: Alright, thank you.

P: OK thanks.


D: I'm going to be having a chat with you today get an idea of how things are going and then I'll go over it with the opposition that I'm working with and we can come back together and talk to you about the next steps, that sound good to you?

P: Yeah.

D: I know that you've been having experiencing a cough. Can you tell me a little bit about that?

P: Yeah, I um I've had this cough for the past two weeks and it just doesn't go.

D: OK. have never had anything like this before?

P: I’m I usually get a cold once a year or so. But the cough doesn't last this long, like it's usually over in a week or week and a half or so.

D: Mm. And it's it's not letting up.

P: Mm.

D: OK um. I'm gonna ask you a few questions about the cough itself. Is this a dry cough that you're experiencing? Or are you producing like any any mucus or coughing up anything?

P: There was some mucus um earlier on, but now it's it's all, it’s a dry cough.

D: Now, it's dry OK how long, what was the timeline for that? I guess how long?

P: Yeah, so maybe for the first four or five days there was this like whitish clear kind of mucus that was coming up and then after that was a a dry cough.

D: OK, OK. And do you feel like the intensity of the cough got worse over the last two weeks, or has it gotten any better?

P: Kind of the same, I would say.

D: And has the cough gotten more frequent over this time as well?

P: No.

D: How often would you say that you're coughing?

P: Uhm? It's hard for me to quantify, maybe a couple of times an hour, maybe three or four times an hour or so.

D: Is there anything you can think of that triggers the cough, or is it spontaneous?

P: It’s kinda, spontaneous um. Can't really think of anything.

D: OK. And along with the cough, are you experiencing any difficulty breathing?

P: No.

D: OK, have you noticed any fevers?

P: Uhm, no.

D: OK um. Have you had any sore throat?

P: Um I did initially um for the first two or three days and then that got better.

D: OK um. Have you had any runny nose?

P: I did initially yeah, I have like had all those flu symptoms for the first couple of days, but the cough just kinda stayed. Everything else resolved in the first uhm three or four days I would say.

D: OK. Thank you for sharing that have you had, did you have any chest pain at any point?

P: No, but I guess like sometimes when I'm coughing too much my chest hurts a little bit.

D: OK, so it feels kind of sore after all that?

P: Yeah.

D: OK. OK, have you been in contact, I guess it's hard to say because it started a while ago, but before it started bringing contact with anyone that's been sick?

P: I I work at the hospital, but. Um I'm wearing PPE all the time, and I'm very careful so.

D: OK. Have you traveled anywhere outside of the province?

P: No.

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

P: No.

D: OK, any belly pain?

P: Uhm, no.

D: OK, um so I'm just gonna ask you some questions about your overall health. Have you had any respiratory problems in the past?

P: No.

D: OK. Or do you have any chronic conditions that you see your family doctor for regular thing?

P: I’ve got acid reflux and uh, I also have anxiety.

D: Are you currently taking any medications?

P: Um. I I used to, not anymore.

D: Uh, was there any particular medication that you stopped recently?

P: No, no. I used to take. I used to take something for anxiety two three years ago.

D: OK. And what do you do for your reflux?

P: I just avoid right now, I'm just trying to avoid the foods that make things worse for me and I feel like that's helped me quite a bit, uhm so yeah. I quite like acidic foods and chocolates and things like that.

D: Sure. That's no fun.

P: Yeah.

D: Do you have any allergies?

P: Just hay fever.

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

P: No.

D: OK, and this is in terms of your lifestyle. Do you live with family, alone?

P: I I live with my partner.

D: OK, and do you have any kids or pets living with you?

P: No.

D: Do you smoke?

P: Uh I don’t, no.

D: Drink alcohol?

P: Um occasionally. On Christmas.

D: Oh OK, I see. And do you use any other substances?

P: No.

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

P: I’m a clerk at the hospital.

D: OK. Right, you just say you working at the hospital. And, uh. I can't think I thought I had another question for you, but I can't remember it. Anything else that you wanted to tell me about that I didn't ask you.

P: Um. No, I guess I was just wondering why I still have a cough. It's been such a long time. Um yeah, and I was wondering if I could get any medications just to help with that. It's not really. Yeah, it's everyone's like scared at work when I cough. I have. I have had the covid test and I don't have it, um so yeah.

D: When we got the last test done?

P: Um I had the test done when I first started having symptoms about two weeks ago? Since then I've been at home and I'm just waiting for my symptoms to get better, but I you know, I kind of like get back, and I don't want to be coughing when I get back. Um yeah.

D: OK. Well, I'm gonna have a quick listen to your heart and lungs I'll do a quick physical exam and then I will go get the doctor that I'm working with all kind of go over everything you talked about, and then we'll come back and talk to you about where to go from here.

P: Sounds great.

D: OK well thanks for chatting with me.

P: Your welcome.


D: What brings you here today?

P: Um so I'm here because my shoulder has been really painful for the past week um and any movement of that shoulder, of my right shoulder, causes a lot of pain.

D: OK, and how long have you been having uh this pain for?

P: For the past week,

D: Past week, OK. Um and did you injure your shoulder at all recently? Any trauma to the area or anything like that?

P: Um so about like, a couple of months ago, I um was do, I I work in construction so um I was moving around some heavy objects and um I guess like the repetitive motions caused some sort of rotator cuff injury. But I had that um, like I got that treated and everything was fine for a couple of months. But this pain just started a week ago.

D: OK, and where is this pain located exactly?

P: Um it's it's just like in my shoulder, like at the joint between my upper arm and um shoulder.

D: OK, and uh is it an aching pain or is it a sharp stabbing pain?

P: So at rest it seems to be like achy and stiff, but um but when I move my shoulder, when I try to move it, it it causes more of a sharp pain.

D: Sharp pain, OK and what kind of movements cause the sharp pain? Or is it just any movement?

P: Uh any movement.

D:  OK. Are there any uh movements that are worse in particular?

P: Um I think um, like no, anything hurts.

D: OK. OK, and how much would you rate this pain out, on a scale of zero to 10, 10 being the worst pain you felt in your life?

P: I'd give it about a 7.

D: Seven, OK.

P: Yeah.

D: And are you having uh, is this pain moving to any other uh joints or any other part of your body?

P: No.

D: OK, so just just in the area that you described?

P: Yes.

D: OK, and do you notice any kind of um, just looking at your shoulder outside, from the outside, any swelling, redness, any masses or deformities?

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

D: OK, alright and um is there anything that you've tried that has helped with your pain?

P: Um I've tried some ibuprofen, some ice. It seems to help temporarily.

D: OK, and earlier when you had the rotator cuff injury, did you get physiotherapy?

P: Um I did. But not, but I didn't finish the full course. I just went for a week or so and then um I had to go back to work, um so I stopped doing that.

D: I see, um yeah, so that's something definitely uh it's very important and we'll need to consider going forward as well. Other than that, are you having any symptoms of any fevers or chills?

P: Uh no, nothing like that.

D: OK, and have you been sick recently at all or met with someone who was sick?

P: No.

D: OK, any any weight loss um or loss of appetite? Anything like that?

P: Uh no, nothing like that.

D: OK, any numbness or tingling?

P: No.

D: Any weakness in your extremities?

P: No.

D: Any um any just symptoms or anything else like diarrhea, constipation, urinary changes? Anything else is going on?

P: No.

D: No, OK. So it's mainly just the shoulder pain?

P: Yes.

D: OK, um alright, and does rest help at all, like when you're lying down, just not moving your shoulder. Does that help with your pain?

P: Uh, yeah I would say so.

D: OK. And is is this stiffness there just throughout the day, or is it there in the morning and then gets better during the day?

P: It's pretty much there all day.

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

P: Uh, I have um, I have diabetes, but that's about it.

D: OK, and do you take any medications?

P: I'm on metformin.

D: OK. Um and do you have any allergies to any medications?

P: No, no allergies to medications.

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

P: No.

D: No, OK. Um any family history of any musculoskeletal or rheumatological conditions?

P: No.

D: OK, and currently right now, so you said you work as a construction worker, right?

P: Yes.

D: And are you off of work right now, or have you been off work um due to your previous injury and pain, or are you still working?

P: I'm still working, but modified, um so I am not uh lifting any heavy objects or anything like that. I'm just doing some like groundwork.

D: OK, that's good. Yeah, I mean, um we might also need to, if you're doing any kind of overhead like work where you're raising your arms above your shoulders, that might uh, cause further problems as well, so we'll look into some of those modified duties as well.

P: OK.

D: Um yeah, and what is your living situation like right now? Who do you live with?

P: Um I live by myself right now.

D: Do you live in a house or apartment?

P: Um I live in an apartment.

D: And, uh, uh, in terms of your daily life, do you smoke at all?

P: Um I don't smoke. I used to smoke before, but that was like 20 years ago.

D: OK, that's good, and do you use any recreational drugs like marijuana or any other drugs?

P: Uh no, no.

D: How about smoking, you smoke cigarettes? Sorry, you said you you quit. Um do you drink alcohol?

P: I'll drink like a glass of wine here and there.

D: OK. Alright, um yeah, and those were some of the questions I had for you. In terms of just a physical examination, uh when you press on the area that you describe, um when you press around the area, does it hurt?

P: I have to press pretty hard for it to hurt.

D: OK, but otherwise it's not tender?

P: No.

D: OK, and again, no swelling, redness, or anything like that, just it's mainly just on the inside?

P: Yeah.

D: OK, and um and any kind of movement hurts, right? There's no particular movement that, like if you were instead of um trying to raise that shoulder by itself, if you were to just move it with the other arm. Does it hurt?

P: The other arm? The other arm doesn't hurt at all.

D: Or like if you were to use your left arm to to passively move your right arm and shoulder. Does that hurt or is it when you just try to move the right arm by itself?

P: It's, oh, it still hurts, any any moving of the shoulder hurts.

D:  OK, alright, so yeah, so based on what um you've told me so far in your recent shoulder cuff injury, what can sometimes happen is uh with those injuries, you might get some um inflammation and what might happen is something called uh adhesive capsulitis, or just commonly knows as known as a frozen shoulder. And there's different stages, so that might happen, so in the initial stages like freezing um and then there's stiffening in stage two, and then usually after 6 to 12 months it starts uh getting better.

P: OK.

D: Um and it might also affect your other shoulder as well. So what we'll um end up doing today is see if um we can get some um imaging done so we can do an X-Ray of your shoulder. I'm sure you've had X Rays before, so we'll kind of compare them to your shoulder X Rays from before. We, if we need to, we can also get an ultrasound if um we don't, uh we can't really tell from the X Rays. And then from there, um we can get some blood work as well. Um just your normal blood work as well as inflammation markers, and then um from there we'll need to uh, really um discuss some management strategies. So you've already tried some physiotherapy, but now we need to make sure that's uh, it's it's consistent because this is something that has a high recurrence rate and we will definitely need to finish the full course of physiotherapy, whatever it may be, um because if physiotherapy doesn't work, we may have to consider like other options like um corticosteroid injections right into your shoulder.

P: OK.

D: For some relief.  But yeah, so first we'll just try some conservative methods like physiotherapy, pain management, uh and then go from there. How does that sound?

P: That sounds pretty good. Thank you.

D: Welcome, alright, so we'll call you for the X-Rays and then we'll go from there.

P: OK, sounds good.


D: What brings you in today?

P: Yeah, I've had a shortness of breath, and even at at rest. Really, feeling like it's difficult to breathe, and when I take a deep breath I get a chest pain.

D: When did this start?

P: This started yesterday.

D: How bad is your shortness of breath?

P: Like, I don't know. I feel like I'm OK, like n terms of being able to breathe, but I mean if I exert myself at all, there's no way I would be able to. It's, I just feel like even at rest it's hard to breathe.

D: OK, has it gotten worse since yesterday or better, or kind of been the same?

P: It's mostly been that been the same or actually sorry it's got, got a little bit worse at first. It was more more with exertion, and now it's, at rest as well. So yeah, it's got worse.

D: I see, OK. Are you able to talk in full sentences or do you need to take a deep like stop to take a breath?

P: I could talk in full sentences.

D: And the chest pain, does it only occur when you take a deep breath, or are there other times as well?

P: I pretty much yeah only when I'm taking a deep breath and say, I mean, maybe that's why part of the I can't take a deep breath so it's making me feel it's making the breathing more difficult making me feel more short of breath.

D: OK. Any other symptoms that you've had? A fever or headache?

P: No, nothing like that.

D: Any cough?

P: Yeah, I, I've had a cough as well over that the same same time period.

D: Is it a dry cough? Are you bringing something up?

P: It's dry, yeah, I haven't brought up any sputum or any any any blood.

D: OK any other flu like symptoms, runny nose, stuffy nose, sore throat? Anything like that?

P: No, I just had um, yeah, the shortness of breath and chest pain.

D: OK, uhm. And have you, I guess I just invited more general questions about others potential symptoms. Do you feel like your heart is racing or do you feel like you have, uhm, do you have any belly pain or any changes in your bowel movements?

P: No belly pain or changes to bowel movements, but I do feel like my heart is beating really fast really fast though.

D: Yeah, OK. Uhm, you said this started yesterday. Were you like completely fine the day before?

P: Uh I was yeah.

D: Anything that's happened recently that's different or new?

P: I'm well it like uh, about two weeks ago I had a hysterectomy 'cause I, for abnormal bleeding. Yeah I had surgery 2 weeks ago.

D: What have you been doing these past two weeks in terms of sort of physical activity? Have you been moving around or no?

P: It's it's certainly been less I I've been moving a little bit, but I've had a lot of pain so I just haven't been doing as much activity, that's for sure.

D: I I see and have you had any, I guess any pain in your legs. Or swelling in your leg? One or the other?

P: Yeah, I have had actually, yeah my right my right calf is pretty sore.

D: Definitely have a look at that. Have you noticed that it's been bigger or more red or warm?

P: Um, no, I don't notice anything like that, just I, just really hurts.

D: Uh, OK. Any medical conditions that you've been diagnosed with?

P: Um, yeah, yeah and I have a high BMI. Type 2 diabetes and anxiety.

D: Do you have any bleeding disorders?

P: Um other yeah, no. I think you're right. It said fibroids.

D: OK, OK. And do you take any medication?

P: Yeah, so uh insulin, well metformin. And then that's it.

D: OK.

P: I'm sorry and then an SSRI. Like I said, low pram for anxiety.

D: Alright. And do you have any allergies?

P: No, I don't.

D: And, who do you.. do you currently live alone?

P: Uh no, I live with my husband and and our two sons.

D: OK and, do you, have anyone sort of come in to help you out over these past two weeks? Are you getting any outside help from nurses etc. Or are your are your family members being supportive and helpful?

P: Yeah, it's been mostly the the family members. My husband's been working from home and the kids have been helpful as well. They are 10 and 12 so they are able to do some things on their own so yeah they've been supportive.

D: That's great. That's great. OK, and you smoke at all?

P: I do yes I I smoke about a half a pack per day.

D: For how long?

P: Um, yeah, but I I started in my, yeah, after the kids were born actually, uh so like 10 years ago.

D: OK, have you tried cutting it down at all?

P: Yeah, I have. I've kind of gone through spurts of quitting and restarting, quitting and restarting. So yeah, I've tried before.

D: OK, and what about marijuana or recreational drugs?

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

D: And alcohol?

P: Yeah I'll have some wine on the on the weekends, but maybe that's like a glass or two.

D: OK, OK uhm, and do you have any medical conditions that long run in the family?

P: Just, uh, yeah, my father actually had a stroke when he was 68, and that's it.

D: OK OK uhm. You haven't ever had one, have you?

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

D: OK, alright. So. I guess come to in terms of smoking, you said that you've tried to quit a couple of times in the past. Do you intend on trying again? I know it can be very hard to, to quit smoking.

P: Yeah, it's only something that is always kind of in the back of my mind.

D: OK, if there's I'm happy to assist you and share resources and problems like medications and things like that that could help you if you're interested so we can talk more about that. talking about your I guess you mentioned that your weight is a little higher than or, its outside the normal range, is that something that you would like to cut down?

P: Yeah, I really try to eat more vegetables and have been trying to do that sort of thing. I've lost a few pounds, but not enough, definitely want to keep going.

D: OK, good good, as long as you feel that you what you're currently doing is helping you and is helping you reduce weight. That's great. But also I'm here for you if you need more education or guidance on that. So, given what you've told me so far, it sounds like you might have developed a clot in your leg somewhere, simply because you had a surgery and you were not moving around very much. Sometimes that causes the blood to kind of, not move around your body is as as much as it usually does, and kind of stays in one place and get turned into a clot and that clot can sometimes get dislodged and settle into your lungs, and that can make it difficult for you to breathe. So, we'll do some tests that that's what my understanding is. Given what you've told me so far, but we do have to confirm it using a test. Also, the fact that you smoke and your weight, and your BMI is high, increases your risk of developing a clot, so I would definitely strongly recommend that you continue to try to reduce both and try to quit smoking. And so we'll do an ultrasound of your leg and we'll do a scan of your chest and see what's going on and then decide if we need to give you any medications, like any blood thinning medications.

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

D: Welcome.


D: What brings you here today?

P: Um hi, yeah I've had the stuffy nose um that's been on and off, as well as a runny nose for the past week and it doesn't seem to be getting any better, so I thought I should come in and get it checked out in case I have covid.

D: OK, yeah I know for sure that's a good idea. So how long have you had this for?

P: A week now.

D: A week. And did. So what started first? Was it the runny nose? Or like the stuffiness?

P: It felt pretty stuffy at first, but now it's mostly running.

D: OK, and are you coughing at all?

P: No.

D: No OK, and the runny nose what kind of content are you producing or draining? Is it mainly like clear or is there any color to it?

P: It's mostly clear.

D: OK. And, is it mainly just congestion and drainage from your nose or are you feeling and go at the back of your throat as well?

P: Uh no it's just mostly for my nose.

D: OK, any other symptoms like sore throat, shortness of breath, fevers or chills?

P: No.

D: No OK. And is this like something that's constant or does it come and go?

P: Ah, it's it's. Ah It's been pretty constant for the past week.

D: OK, has this happened to you before at all?

P: No, well, actually I've had I've had a cold before but not recently. Maybe like five years ago.

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

P: Um I've tried like decongestants and. That's not. Well, I guess my nose is runny now so that worked a little bit.

D: OK. OK, and have you been in contact with anyone who's been sick recently?

P: Uhm? No, I don't think so. My I have um a nephew who I live with who goes to daycare.

D: OK, and has he been sick at all?

P: No, he's been fine.

D: OK, any recent travel at all?

P: No.

D: No, OK. Any headaches or nausea or vomiting?

P: Nope, nothing like that.

D: OK, any fatigue?

P: A little bit.

D: OK, any loss of sense of taste or smell.

P: Um. No, um not that I've noticed.

D: OK, any sort of like chest pain or racing sensation of racing of yourbheart or anything like that?

P: No.

D: No OK? Any changes in your bowel movements?

P: No.

D: How about your any difficulties in urinating?

P: Um no.

D: OK, have you been sleeping and eating well?

P: Yes.

D: OK, any weight changes like any significant weight loss recently?

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

D: OK. At home or at work home any exposure to like fumes, dust or animals?

P: No.

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

P: Um I have type one diabetes.

D: OK, and when were you diagnosed with that?

P: When I was like 7.

D: OK. And so you have your insulin medication and your are you all up to date with that?

P: Yes.

D: OK, and do you see an endocrinologist?

P: I do.

D: OK, alright. Any medications that you are on besides insulin?

P: Uh no .

D: No, OK. Any allergies at all?

P: No.

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

P: No.

D: No, OK. Any family history of any medical conditions, in particular with the lungs or the heart.

P: No.

D: No, any autoimmune diseases?

P: No.

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

P: I’m in school right now.

D: OK, and so are you living, where are you living right now?

P: I live in an apartment by myself.

D: OK. And currently, do you use any recreational drugs like marijuana or anything?

P: Uh no, not OK so not frequently, but maybe like once a month I'll have an edible.

D: OK, any other recreational drugs like cocaine and heroin? Anything like that?

P: Oh no.

D: No. And you drink alcohol?

P: Uh no.

D: And do you smoke tobacco?

P: No.

D: Yeah, those were all the questions that I had for you today. Do you have any questions for me?

P: I yeah, how do I get rid of this? And it's really been bugging me.

D: Yeah, it kind of so just a stuffy nose in the runny nose it seems like it's most likely a viral infection like the common cold. It takes a few weeks for the symptoms to get relieved, but there's not much that we can do besides supportive care, so make sure you get you stay well hydrated. You can use over the counter medications uh like Tylenol cold. now, if you to relieve some of your symptoms, but since right now we're in a pandemic, some of these symptoms can also be seen in covid patients, so we will also get a swab done for you today, and you should have the results back by 48 hours. Um until then, we recommend that you stay isolated in your own home and not see anyone else. And then once the results come back, you'll get further instructions from public health.

P: OK, that sounds great. Thank you.

D: Your welcome. Take care

P: You too bye.


D: What brings you in?

P: I just came in because of I just got into like this uh, incident while I was playing rugby. I kind of got tackled and then fell onto my right shoulder. Um, and after I got up, I haven't, I've just been, this just happened a couple hours ago actually and uh, I've just been in intense pain in my right shoulder and I can't seem to move it at all.

D: Okay, um, and sorry, when was this exactly?

P: Uh, probably 2 hours ago.

D: 2 hours ago, okay. Um, and is this pain persistent or is it like on and off?

P: It's, it's constant. It hasn't gone away at all.

D: Okay. 1 to 10, 10 being the worst. How bad is this pain?

P: I don't know, like probably like 8 or, 8 or 9.

D: 8 or 9, okay. Um, and is it a sharp kind of pain or is it dull and aching?

P: It's, it's sharp. Like if I try to move it at all, it's like a sharp pain.

D: Okay, um, and have you ever had anything like this in the past?

P: Uh, no, never.

D: Never, okay. And are you able to move your arm at all or you can't move it?

P: I could move my fingers and hand and elbow, but um, elbow a little bit, but like uh, yeah, I can't move my shoulder whatsoever.

D: Okay, um, and do you, are you experiencing any tingling or numbness?

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

D: No, okay. Uh, how about any muscle weakness?

P: Um, in that area, I don't know if it's weakness or pain, but I just can't move it up and I, I, I do feel some like numbness just above my shoulder. No tingling though.

D: Okay, any pain elsewhere in your body?

P: No.

D: No, okay. Any headaches?

P: Um, no.

D: Confusion or memory loss?

P: Uh, no.

D: Uh, weight loss?

P: Uh, no.

D: Fevers or chills?

P: No.

D: Rashes?

P: Um, no.

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

P: Uh, no.

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

P: Um, no.

D: Chest pain or heart palpitations?

P: No.

D: Changes in your bowel movements?

P: No.

D: Changes in voiding?

P: No.

D: Um, okay. And then with regards to this pain, does anything make it better or worse?

P: Um, um not anything that I've tried that's made it better. Worse is probably just if I try to move it at all.

D: Okay, and the pains in your shoulder, does it radiate down or up elsewhere?

P: Uh, mostly towards my shoulder, um, kind of down towards my upper arm as well.

D: Okay, I see. Um, alright, and um, are you otherwise healthy? Do you have any other medical conditions?

P: No. Yeah, otherwise I'm healthy. I've never been to the doctor much.

D: Okay, alright. Um, and are you on any medications?

P: No.

D: No, okay. And um, are you up-to-date with your immunizations?

P: Yes.

D: Okay, and do you have any allergies?

P: Uh, no.

D: Any family history of musculoskeletal diseases?

P: No, not that I know of.

D: Okay. Uh, and any family history of autoimmune conditions?

P: Um, no.

D: Okay. Um, do you smoke at all?

P; No.

D: No. Um, do you consume marijuana?

P: Uh, no.

D: Uh, do you drink alcohol?

P: Uh no, just, just with friends sometimes on the weekends, but not really.

D: Okay. Um, and then, where do you live right now and who do you live with?

P: Uh, I live just outside of town with my parents in a house.

D: Okay. And um, have you traveled anywhere recently?

P: Um, no, I've been at home.

D: Okay, any sick contacts?

P: No.

D: No, okay. So now we're just going to move on to um, the physical exam part of this. So can you take a look at both your shoulders and let me know if you see any redness or swelling?

P: Um, I don't think I see any redness or swelling, but um, my right shoulder and my arm just seems a little bit lower than my left one.

D: Okay, okay, any um, warmth on, on that shoulder?

P: Uh, no, not that I can feel.

D: Okay, any atrophy, deformities, or skin changes?

P: Um, deformity, I, I do feel like kind of uh, like my shoulder's dropped and like there's just kind of this uh, little, like divots, where like the shoulder should be.

D: Okay, okay. And can you palpate that area for me? Just um, the bones in that area, so like right where your arm would connect to your shoulder and then kind of on your shoulder blade. Does that hurt when you press down?

P: Yeah, it hurts a lot.

D: Okay, so some tenderness and pain in the acromion process and scapula. Um, and if you press down on your biceps, triceps, does that hurt?

P: Not as much, no.

D: No, okay. And then can I get you to um, can you lift your shoulder up at all? Like to where, to the point where your fingers are touch, like reaching the ceiling?

P: No, I, I can't. I can't move it at all.

D: Alright, so um, it sounds like you have a shoulder dislocation. Um, so we are going to do an x-ray of your shoulder joint first to make sure that it's, it's just a dislocation and there aren't any broken bones or fractures. And then um, we can resolve this by doing something called a closed reduction, um, to try to put the joint back in its place.

P: Okay.

D: Um, and if that closed reduction doesn't work, then uh, you may need surgery for like a, um, a weak shoulder joint, or if like ligaments um, aren't like, strong enough and it's it continues to happen.

P: Okay.

D: Um, otherwise, we can keep it immobilized for a few days to a few weeks, um, depending on how bad the dislocation is. Um, and then once that's removed, you can do some rehab as well to restore some range of motion. Does that sound like a good plan? Do you have any questions or concerns in the meantime?

P: Uh, no, I think that's, uh, that's great.

D: Okay.


D: How can I help you today?

P: Um yeah hi, I brought I brought my 8 year old daughter here um because I've noticed that she's been quite wheezy um for the past four five days and now she has a slight cough, um sounds like she's a little short of breath, so I just wanted to get things checked out.

D: OK, so for the, when it first presented, about four to five days ago, what did you notice, notice first?

P: Um I noticed that she was wheezy um and it's it seemed like she was having some difficulty taking in deep breaths.

D: OK, now was this with any type of activity or just at rest?

P: Yeah, she was playing tag with one of her cousins and she she was quite out of breath after.

D: OK, has she ever had anything like this before?

P: No.

D: Nothing like that, OK, and has it been fairly steady since then? Or has it been fluctuating?

P: It's been fluctuating.

D: OK, but it hasn't really gone away in the sense that you're still concerned coming now four days later?

P: Yeah, it's just it would, she would have these these uh episodes, but it would resolve on its own and then she would, you know go back to doing some sort of activity and then she would have all these symptoms all over again, but when she rests um then it goes away, so I wasn't really sure, too sure what to think of it. But now I think it's important to get it checked out, so here we are.

D: Has she had any fevers at home?

P: No.

D: Has she had a runny nose at all at home?

P: No.

D: Has she seemed well otherwise, does she look sick?

P: Yeah, she looks fine otherwise.

D: OK. And has she had any sick contacts recently? Anyone around her or her friends been sick?

P: No, not that I've noticed.

D: OK. Any recent travel anywhere?

P: Uhm, no, no, we didn't go anywhere because of covid.

D: OK, but she's still been going to school I suppose, playing with her friends?

P: Yes.

D: OK. Have you noticed any rashes? Any skin changes anywhere on her body?

P: Uh not that I've noticed, no.

D: OK, nothing like that, has she complained of any pain anywhere?

P: No.

D: OK, and has she had any recent infections?

P: Uh she had, actually she had a couple of infections over the past two years. Uh they would come and go uh and we took her to the doctor each time and it just ended up being some sort of viral infection.

D: OK, so nothing really needing antibiotics in the last couple of years?

P: No.

D: And in terms of how she's been doing, has she been keeping up with her peers in terms of education, and how she moves, how she acts?

P: Uh yeah, she's been yeah, she's been on par with her peers.

D: OK, so does she have a family physician?

P: Um yes.

D: OK, so they haven't brought up any concerns about how she's growing, how she's developing?

P: No.

D: So her weight, her height, they've been good for her age?

P: Yeah, yeah.

D: Excellent. And has she gotten, has she been keeping up to date for immunizations?

P: Yes, she's fully up to date.

D: Excellent. In regards to how she's doing, otherwise health, in terms of her health, has, did she see a family physician for any other medical issues that she might be having?

P: Uh no, she's otherwise pretty healthy.

D: OK. How was the birth? Was there any complications when she was born?

P: No, she was a vaginal delivery, full term, no complications.

D: OK, so nothing when you were pregnant with her, no toxic congestions? By that I mean um did you drink any alcohol, smoke at all when you were pregnant with her?

P: No.

D: No, OK. And you just had antenatal care, so you saw doctor for ultrasounds and just for checkups?

P: Yep, everything was fine.

D: OK. And when she was born, she didn't have to stay in the hospital at all?

P: No, no.

D: And was she born, uh what weight was she when she was born?

P: Uh, she was, how much was she? I think she was about 8 kilos.

D: 8 kilos?

P: Sorry 8 pounds, 8 pounds.

D: Yeah, no worries. And then otherwise she is, so she's been healthy otherwise, been doing well, uh just in terms of how she's been doing uh with other systems of her body, have you noticed any concerns for her bowel movements?

P: Uh no, she's been pretty regular.

D: OK, any concerns for peeing?

P: Uh no, she's been going pretty frequently and she's, yeah no changes there.

D: And we already talked, she hasn't had any fevers, when she coughs does she ever bring anything up?

P: Uh no, I haven't noticed any phlegm, no.

D: OK, and when she's having these wheezy episodes, do you ever notice that she looks like she's really straining to breathe, really struggling?

P: Uh yeah, so she, it's not like she turns blue or anything like that, um she just slightly slightly has a hard time catching her breath.

D: OK, so these usually recover on their own?

P: Yeah.

D: You don't give her anything for it?

P: No.

D: OK, uh does she have any allergies?

P: Um no, well she has some seasonal allergies, but nothing that she's been tested for.

D: OK, do you give her anything for seasonal allergies?

P: Sometimes she takes like Reactine or like over the counter stuff, but um no, no prescribed medications.

D: OK, so she doesn't have any allergies where her face swells up or she has trouble breathing?

P: No.

D: OK, and this, these episodes mainly happen when she's playing with friends, so do they happen in a certain environment? Like for example, is this in a friends house or is this outdoors or has it been across different settings?

P: It's been across different settings but I will say it's worse when um when when there's colder weather.

D: OK.

P: Yeah.

D: And do these episodes ever happen in your home?

P: Yeah.

D: And what's the context from them happening in your home?

P: Um usually when she is out and about running around in the backyard with her friends um is when I've mostly noticed it, yeah.

D: OK, so she doesn't have any symptoms at rest?

P: Oh, no.

D: And she doesn't have any symptoms at night?

P: Uh at night, so there was one one one night when she had some issues um with like wheeziness but it did resolve on its own.

D: OK. And did she wake up at night with that or just?

P: Just trouble falling asleep, I think yeah.

D: OK. Alright, so we already talked about, so she doesn't really have any past medical issues that she's seen a doctor for, uh any surgeries?

P: No surgeries.

D: OK. Is she taking medications right now?

P: Um no, no medications.

D: Aside from the occasional Reactine?

P: Uh yeah, aside from that, nothing, no regular medications.

D: And she's in school?

P: Um yeah, she's uh she's in Grade 3 now.

D: OK, and does she live with you?

P: Uh yeah she lives with me and my husband.

D: OK, do you two live in a house in town?

P: Um yep, in a townhouse

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

P: Um so my husband is an ultrasound technician and I am a uh kindergarten teacher.

D: OK, excellent, and this is a question we just ask everyone, has there ever been any CC CAS involvement in the family?

P: No.

D: And does anyone smoke in the household?

P: Uh, no no.

D: OK, uh do you keep any carpets or pets in the household?

P: We have carpets, but they're new carpets. We just got them, uh maybe six months ago, and nothing else.

D: So no pets, no dogs?

P: No.

D: OK. Any wood burning fireplaces, stoves in the household?

P: No.

D: And changed your air filters?

P: Yeah.

D: Alright, excellent, so I think I have all the information I need, we're just going to do a physical exam and then I'm going to go talk to the physician and I'll come in and see your daughter and we'll talk about next steps from there. Do you have any questions that you'd like me to direct to him before that happens?

P: No, thank you so much.

D: Alright, have a good one

P: You too, bye bye.


D: What brings you in today?

P: Hey, so I just for the last couple days I've just been feeling really short of breath really rundown. Just like super tired and you know, normally really active and I'm just, I'm just having a rough go.

D: Is there is the shortness of breath knew for you?

P: Yeah yeah, it's just like just like I can't. I don't know like I can't catch up. I kind of just feel I feel a bit weak like I've just been feeling really tired and then because of that I haven't really been eating a lot so. Yeah, I don't know.

D: So. You've just been feeling very tired, can you I guess, like tell me a little bit more about your difficulty with breathing. When does it happen?

P: I think just like overall, I'm finding it like it's hard to hard to get like super deep breaths it's not like I I can't. I don't get the feeling that I can't breathe. It's just that everything's a little bit more like laborious.

D: OK. And you said that it started a few days ago. Have you had any other symptoms other than the difficulty breathing and the fatigue?

P: I mean. I felt I think I felt really hot yesterday. I don't know the thermometer, but I had my wife put her put her hand on my forehead and she got a I felt pretty warm. And come to think of it, I this morning I, I really I didn't eat much because I just haven't been that hungry, but I don't really feel like I couldn't really taste my breakfast.

D: Has that ever happened to you before?

P: No never I like, I like my food.

D: Me too, um OK, what about your sense of smell? Do you feel like you're not you are not able to smell well either?

P: I haven't thought about it too hard, but yeah, kind of.

D: OK. And have you had a cough?

P: Uh I don't know I. I feel like I maybe could be starting starting one.

D: Sure.

P: Like it's when it feels dry like it's on its way. Haven't really been coughing much.

D: I see, what about a sore throat?

P: I’m starting to feel a little bit like that. Like I don't know if I'm imagining it, but yeah, I I think so.

D: I see OK. Have you had a runny nose or any congestion?

P: No.

D: Any headaches?

P: Uh. Good question, I I kind of I get I get headaches fairly often I don't think I'm getting any more than usual, but I have had a little bit.

D: OK. Is the headache that you've had different in quality from the headaches that you usually get?

P: I mean, I don't know, I don't know. I usually get kind of difficult stress headache, you know?

D: Yeah yeah.

P: Pretty well. I am stressed, just that I you know, might be sick.

D: And have you had any changes in your vision or hearing?

P: No.

D: In the past three four days, no OK. Any nausea or vomiting?

P: No, no, I haven't.

D: Have you had any chest pain?

P: Uh, like it's. No, yeah no. No chest pain.

D: Any do you feel like your heart's beating really fast?

P: No, I wouldn't say so.

D: OK, have you had any pain in your belly?

P: No. Cause I I meant I haven’t really been eating but yeah.

D: OK, any urinary symptoms?

P: No, I don't think so.

D: OK. And you mentioned you have muscle aches, is it, so all over your body or is it a specific part, specific area?

P: I would just say I feel kind of overall achy.

D: OK,

P: Um not any one spot.

D: Any numbness or tingling in your arms or legs?

P: Uh, no.

D: OK. All right, have you had any exposure to anyone who could potentially be sick?

P: Well. My grandkids, uh, visited last weekend and my grandson has a cold. He goes to daycare. Yeah, so I'm not really. I'm not really sure like he's been staying home and they didn't. They didn't really know that when they came to visit.

D: OK, that's yeah, uhm OK. And have you traveled anywhere outside the province?

P: No no.

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

P: Uhm? I'm pretty, I'm pretty healthy. I have some um like reflux that I see my doctor for. And I've had I've had some difficulties like with like urinating a little bit. Yeah, my my prostate's a little big like it's not cancer but. So just those two things that aren't that aren't there that really big deal they don't affect my life too much.

D: Are you taking any medications for either problem?

P: I take avodart.

D: OK.

P: And for the the reflux I take a tums here and there I used to be on a medication, but it seemed like I kind of figured out the foods that were going to help, so I stopped.

D: Great, that's great. Any allergies to medications, foods, or environmental allergies?

P: Uh no, no

D: No, and any medical conditions that run in the family? Specifically, anything related to the lungs?

P: No, not that I can think of.

D: And do you you mentioned that your grandkids have came to visit. Do you live alone?

P: Uh no. I live with my wife.

D: And are you currently working or are you staying at home?

P: Uh, I'm working from home. I I, I've gone out a few times to see clients. I work as a financial advisor. I've gone to see a couple clients that are really old and have a hard time doing stuff over the phone or over the computer, but I'm like 95% from home.

D: Have you gone to see any clients in the past three or four days or in the past week?

P: No, no, it's probably been a couple weeks since I saw anyone .

D: Sure OK. And do you smoke? Or did you ever smoke at the past?

P: No, I I maybe did for maybe like three years in my 20s. It wasn’t heavily yes.

D: Any marijuana or recreational drugs?

P: No.

D: Any alcohol?

P: I usually have a whiskey or two on the weekends.

D: OK alright. Uh so it sounds like you have some sort of an infection with the fevers and fatigue and muscle aches, and then the difficulty breathing, of course, and then your sensation, that sensation that you are having a very cool sort of a sore throat and cough that you might be getting. We can't necessarily rule out covid just yet.

P: Thats what I was worried about.

D: Yeah, and given that you're having difficulties breathing, we're also going to have a look at your chest and do it physical exam, but also do a chest X Ray just to make sure, or just to see if there's anything a infection that is settling in your chest, and a covid swab and then uh go from there. We’ll decide whether you need to stay in the, you need to stay in the hospital and if you can go home based on those results, but if you are to go home, we would request that you stay away from from everyone, so including your wife. Try to self isolate as much as possible and your results should come out in 24 to 48 hours and then the public health nurse should tell you what to do if your results are positive.

P: OK, OK no, that sounds fair,

D: All right. Well, let's do a physical exam and then go from there.

P: OK. Thank you.

D: You're welcome.


D: How can I help you?

P: Hi, I just was brought in here today. I had a fall just waking up coming down the stairs. I fell off the last few stairs and just fell onto the right side and on, right onto my head and now, uh I couldn't even I could barely stand up and put any weight on my hip. It's the right hip.

D: OK, Uhm, so what caused you to fall in the 1st place? Did you just lose balance, were you dizzy?

P: I think I just I missed, I wasn't dizzy or anything. I just missed one of the steps and just slipped, slipped down the stairs.

D: OK.

P: But it was just the last few stairs I didn't have like I didn't hit my head or anything like that.

D: OK, and when was this?

P: This was a so I guess now two hours ago.

D: Two hours ago, OK. Has a pain been constant since?

P: Yeah, it's, it's really excruciating.

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

P: No, it's I'm just in extreme pain. Like I I I can't even put any weight on it.

D: OK, so you can't, OK so you can't weight bear, and you can't walk on on that leg I guess.

P: Mhmm.

D: OK. Is it a sharp kind of pain or is it dull and achy?

P: It's uh, it's pretty sharp, like if I'm not putting any weight on it right now, it's like really achy. But if I put any weight on, it's really sharp.

D: OK. And where is this pain exactly? Is it just in your right hip or is it radiating up into your upper anterior lower back or down to your leg?

P: It's in the right hip, mostly just on the side, but the pain is kind of like, all over the right side of my groin and I feel like there's some swelling there as well.

D: OK. And one to 10, 10 being the worst pain ever. How bad is your pain?

P: I would say 10, like I've never experienced pain like this.

D: 10, OK. And do you, have you ever had pain like this before? Like have you ever had a fall in the past?

P: No, this isn't this is the first time I've had a fall.

D: OK, any numbness or tingling?

P: Uhm, no, not that I can tell, no.

D: Dizziness or fainting spells?

P: Uhm, after the fall out like this, I I don't know if it's due to the pain, but even in the ambulance, coming out of the ambulance I was feeling a little bit dizzy, but I don't know if that's just 'cause of the pain.

D: OK, any headaches?

P: No.

D: Confusion or memory loss?

P: No

D: Uh, joint pains or muscle aches elsewhere?

P: No

D: Weight loss recently?

P: No.

D: Fevers or chills?

P: Nope.

D: Uhm, and rashes?

P: Uh no.

D: Any changes to your vision, hearing, smell or taste?

P: No.

D: Any, uh, you experiencing any cough, uhm, shortness of breath or wheezing?

P: No.

D: OK, how about chest pain or heart palpitations?

P: No, not that I have experienced.

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

P: Nope.

D: OK, how about changes to urine?

P: No, nothing.

D: OK. And. Are you otherwise healthy? Do you have any longstanding medical conditions?

P: Yeah, so I just have a, uhm I do have some osteoarthritis and then I have, I take this medication for blood pressure. It's called uh, Ramipril.

D: OK. OK, and is that the only medication that you're on?

P: Uh, yeah. And then I'm just on vitamins like vitamin D, calcium and just multivitamins.

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

P: Yes.

D: Yeah, OK. Any allergies?

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

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

P: Uhm, I think, uh my father, he died of a heart attack in his 60s.

D: OK, OK, any musculoskeletal issues?

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

D: No. Uhm, how about autoimmune conditions?

P: No, not that I know of.

D: Any cancers?

P: Uh, I think, my, my mother had some skin cancer, but the ones that, she didn't need any surgery, they just zapped them off.

D: OK. Uhm and do you smoke?

P: No, I've never smoked?

D: OK, uhm, do you drink alcohol?

P: Just maybe like a wine, what every other day, a glass of of wine.

D: OK, and then do you consume marijuana in any form?

P: No.

D: OK. And how about in terms of where you live? Who do you live with and where do you live?

P: I live with uhm, just my husband and and we just live in a small apartment.

D: OK. And have you been in touch with any, anyone sick recently?

P: Uh. No, I've I've been like at home with my husband. We haven't really left.

D: OK. And have you done any travel recently?

P: Uhm, no, I've just stayed at home.

D: OK. Alright, so let's move on to the physical exam part of this interview. So if you can, I'm going to get you to take a look at both your hips as well as your legs. Do you notice any redness or swelling in the area?

P: I do notice some swelling. It's a little bit red. I can't really see too much red.

D: OK. OK. Any muscle atrophy? Any deformities or skin changes like bruises?

P: Uh, maybe some bruising, but I, I don't notice anything else.

D: OK. Alright. And then when you place the back of your hand on both hips, do you notice any temperature changes? Is one side warmer than the other?

P: It's a little bit warmer, the right side than the left.

D: OK, and does one like appear to be shorter? Or does does it appear to be misaligned? Or in any sort of like strange positions like outward turning of your leg, one compared to the other?

P: I think it's a bit, but look at it a bit, like outward turning. And then yeah, I would say it's more outward turns.

D: OK, and if are you sitting down right now?

P: Uh, yeah.

D: OK, are you able to stand up from a sitting position?

P: I can try, but it's very painful.

D: OK.

P: Yes, should I go ahead and try?

D: Yes please.

P: Yeah. So I yeah I can barely stand up. I can't, it's kind of just, I'm just supporting myself with my left like.

D: OK and so I, I guess you can't do any of the like hip flexion or hip extension, hip abduction or addduction, correct?

P: No, I can barely move it.

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

P: No, I think I I just don't know if I need surgery or something.

D: Yeah, so it sounds like you have a hip fracture from your fall. Uhm, so, the way to treat this is a combination of surgeries and rehab and medication. So we will definitely look into the surgical option first, which is done using some internal repair with screws. Or, you can do a total hip replacement or a partial hip replacement. The orthopaedic surgeon will uh, decide like which option is best for you after we refer you for a consult with them, and then after that surgery they'll likely refer you to some rehab, so physiotherapy will focus on improving your range of motion and strengthening the muscles in that area. Uhm, and for management of pain, you can take ibuprofen or any over the counter pain medications for now. Does that sound OK?

P: Yeah, that sounds good. Thank you so much.

D: OK, great, no problem.


D: Uh how may I help you?

P: Hi, so yeah I just came to the hospital because I've just been feeling over the last um few days uh just I can't really take like a deep breath. And then I've also been coughing up uh this greenish yellowish material.

D: Oh OK, and when did this uh cough start? Sorry.

P: So I think the cough started like 4 days ago and then the shortness of breath started uh just yesterday.

D: OK, um and it's been yellowish green, were you coughing up sputum prior to this and um or did you have a cough before this?

P: No, not really.

D: OK. Um and have you noticed any blood?

P: No, no blood.

D: Alright, um and the shortness of breath, are you experiencing this at rest or um or with exertion?

P: No, like at rest, even right now I'm like having trouble taking deep breaths.

D: OK are you feeling any uh any chest pain?

P: Um not pain, but there's definitely some straining and discomfort when I take a deep breath.

D: OK is it, is the discomfort worse when you take a deep breath?

P: Uh yeah, it's just like I just have to strain a lot to like take that deep breath.

D: OK, um and uh have you noticed any wheezing?

P: No wheezing.

D: OK, um and have you had any shortness of breath or do you have any shortness of breath if you lie flat?

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

D: OK, or have you had any uh times where you've uh woken up um from sleep because you were short of breath and you had to sit up?

P: Uh no.

D: Alright. Um and have you had any uh fevers or chills?

P: I have had a fever like today, I had a fever I measured it was like 38.5. Yesterday, I felt like I had chills and a fever as well.

D: OK, yeah, certainly sounds like a fever and have you had any night sweats?

P: Last night, I would say I had night sweats. My sheets were a bit drenched.

D: OK. And have you had a sore throat?

P: No.

D: Changes to uh, loss of smell, loss of taste?

P: No, nothing like that.

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

P: No.

D: OK, um and how about any eye symptoms like redness or itchiness, pain?

P: Uh, no, nothing like that.

D: OK. Uhm and um have you had any uh instances of fainting or feeling dizzy?

P: Nope.

D: Any abdominal pain?

P: No.

D: Any nausea or vomiting?

P: No.

D: Any diarrhea?

P: No.

D: OK, any rashes?

P: No rashes.

D: Um and then any muscle aches or body pains?

P: No, not that I know of.

D: OK, and how has your energy been? Have you had any fatigue or malaise the last several days?

P: Yeah, I would say so. I just feel like I don't know if it's to do with the short, of being short of breath, but yeah, I just feel like I've just been needing more rest.

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

P: No.

D: No, alright, um so you've had this uh cough and you've been bringing up more sputum and shortness of breath and um and you've had a fever as well, um have you been experiencing any other symptoms?

P: Um no, I think those are pretty much all the symptoms.

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

P: I do have, uh I take medications for high blood pressure. Um then I take medications for high cholesterol as well.

D: OK. Um and do you take any other medications?

P: Um just uh vitamin D calcium multi vitamins.

D: Alright, any allergies to medications?

P: Not that I know of.

D: Alright, any prior surgeries or hospitalizations?

P: Uh yeah, I've had a few. Uh so I had a C-section in my twenties. Um then I had just uh five years ago, I had a um my gallbladder removed.

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

P: Yeah, so I'm living alone right now. Um, just in an apartment.

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

P: Uhm no I, not anyone that I know of. I do, I I did see my just randkids just last week, though.

D: OK, did they have a runny nose? Any symptoms like that?

P: Not that I noticed, no.

D: OK. Um have you traveled anywhere recently?

P: No, I've been at home.

D: No, OK. Um and and do you smoke cigarettes?

P: No, I probably smoked for a very short time for like probably five years of my life in my 20s.

D: OK, uh, do you smoke um marijuana?

P: No.

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

P: No.

D: OK. Um and um any family history of heart or lung conditions?

P: Uh, I do have uh, my father passed away from a heart attack in his 50s. My brother has um high blood pressure, diabetes. Um and on my mom's side, she had like osteoarthritis.

D: OK, and any cancer that is in the family?

P: Um skin cancer, on my um father's side.

D: OK, um and have you had antibiotics recently or within the last six months for any reason?

P: No, no antibiotics.

D: OK, so, so that was everything that I wanted to ask today on uh on history. Um was there anything that you also wanted to mention I I maybe forgot?

P: No, I think that's all.

D: Um OK, so uh yeah, with the the symptoms um it could be um pneumonia which could be bacterial or viral, um as well as the possibility of um something like uh like Covid, which is of course a concern for today. So we will go ahead and start those investigations and get a swab. Um and um you may need antibiotics for um for this, if there there is uh pneumonia so we'll also get a chest X-ray as well.

P: OK, alright sounds good.