D: So what brings you to the clinic today?

P: Hi so I just like for I don't know like three or four days I’ve been having this really dry cough and my throat feels really scratchy. I just feel kinda crappy overall. And my head’s pounding

D: Your heads pounding. You have a headache right now?

P: Yeah, little bit. I just kind of feel just icky.

D: OK, and you say I've been feeling that for three to four days now.

P: Yeah, yeah exactly

D: What did you first notice?

P: I first noticed that my throat was kind of scratchy and then I started coughing, but it's really like dry.

D: OK, so you haven't been bringing anything up with it?

P: No,

D: Any flem?

P: no nothing.

D: OK, you haven't been noticing been running a temperature at home. Have you hot fevers?

P: I have felt really hot.

D: You felt hot at home, OK,

P: yeah,

D: You noticed any night sweats by night sweats. I mean you wake up sheets are soaked.

P: I honestly I felt hot like all the time like yeah yeah night. I feel hot but during the day too I'm just like I'm I'm like hey I'm wearing like just shorts and like a tank top and I just still feel really hot.

D: OK. You notice, skin changes anything in your arms or legs it looks weird? New rashes?

P: I don't. I don't think so. I haven't really been looking, but you know.

D: No worries and then aside from that, any nausea? Any vomiting?

P: No, not that. No, nothing like that.

D: Any diarrhea?

P: No no.

D: Any aches in your joints anywhere?

P: No. I mean, I'm I'm tired, but I don't think they're not like hurting.

D: OK, so aside that aside from kind of this dry cough feeling hot that otherwise you're feeling OK. You don't have any other real concerns aside from that.

P: Yeah, just like I just feel crappy like. Yeah, I really. I don't think I know that's not like a a real like way to say.

D: Oh no, no, it's perfectly valid. We called that Malays in general. Just feeling a little bit off. Alright so this is going to talk about you for a little bit, but first, we'll get to that later. So any issues that you've seen a doctor for before?

P: I have I have allergies. Usually in like the spring in the fall.

D: Do you have any allergies to any medications?

P: No, no nothing like that. It's just like I get, really bad allergies like I I've seen an allergist and some years I've gotten allergy shots. But like not every year. Otherwise, I'll take like Claritin. This isn't like this is maybe around like this is just before they normally start, so I don't really have them right now.

D: OK.

P: Probably like in a few weeks they'd be really bad.

D: Now do any of these allergies can't make it difficult to breathe or you feel like your face is swelling up?

P: Uh. Like it feels like a little bit like plugged up an like what's that called like post nasal drip? But I don't really feel like I can't breathe.

D: It's just like a little stuffy.

P: Yeah, yeah, exactly.

D: And these shots at the allergist gave you, how often would you get those?

P: Those are the ones that I'd have like once. Usually like once a week for a little while, like in the winter before.

D: OK, so you don't carry an EpiPen with you.

P: No, no, they said it's not like one of those allergies and it's just like it's just like the seasonal ones. But they're just bad.

D: OK, sounds good. So you've seen an allergist. Any other doctors that you've seen in your life?

P: My family doctor. I don’t really go very often.

D: OK, has there been any health issues that you've had in the past?

P: No, like I've been really healthy. It's just like the allergies and.

D: OK, any surgeries in your life?

P: Uh, no, no.

D: No. Are you takin any medications right now?

P: I take. Claritin for allergies but I haven't like right now. I just have it with me just in case. I take birth control.

D: What type of birth control do you take?

P: Deyo

D: OK and you take that regularly?

P: Yeah, it's just like the pill. It's like the one that goes for three months.

D: OK, so you don't have an IUD now you just take the oral contraception?

P: Yeah yeah, just the pill got it.

D: Got it. OK and then so you never had asthma in your life?

P: No.

D: OK, any family history of asthma?

P: Like my cousin.

D: OK, what about your parents, brothers, sisters?

P: No, nothing like that.

D: Do you know what eczema is?

P: Like, I've heard of it.

D: OK, anyone in the family have it?

P: No. Like the only thing, like my dad has allergies too. Same kind as me.

D: OK . Dad has allergies. OK, mother and father still alive?

P: Yeah.

D: Healthy?

P: Yeah.

D: OK good, do you live with them right now?

P: Yeah, yeah, like I'm in high school.

D: OK so you live in a house with both your parents. OK any brothers sisters?

P: Yeah I have a little brother.

D: How old’s he?

P: Like 14 now.

D: Has anyone in the family been sick recently?

P: I think my brother we had like a cold a few weeks ago

D: He had a cold.

P: Yeah.

D: OK.

P: But like we are doing our school from home now so.

D: Got it.

P: My mom works from home and my dad just works like on the farm so. So no one's been like seeing anyone or going anywhere to get sick.

D: OK, so sorry, do you live on a farm?

P: Yeah,

D: OK, in London?

P: Like just outside.

D: OK. Any travel or anywhere recently?

P: No, like I just just came here. But like I don't really leave the house

D: So last last two weeks you haven't left the country?

P: No.

D: Nothing like that.

P: I wish.

D: You keep any animals on the farm?

P: We have like a dog, but it's not like an animal farm

D: Got it. OK, another questions, are you sexually active?

P: Uh no.

D: But you're taking the birth control? OK, so when was your last menstrual period?

P: Like like I just got done like a week ago.

P: A week ago. And you haven't been sexually active since then.

P: No.

D: OK. So chances of being pregnant very low.

P: Oh Oh yeah yeah, it's been like a year.

D: Got it got it alright, do you smoke? Cigarettes?

P: No.

D: Do you drink alcohol?

P: Like before Covid, when I saw my friends like sometimes a little bit but like not really anymore.

D: OK, how much would you drink when you went out?

P: Oh like, I mean, our parents would sometimes let us have like a couple coolers, but like that, was it?

D: Got it. Any other drugs? Marijuana, cocaine?

P: Like I tried marijuana once at a party like a couple years ago, but like I had, I never did it again.

D: Got it so none of the harder drugs, cocaine, heroin?

P: No.

D: And I gotta ask this question for everyone. Have you ever injected drugs or anything into your arm or your body?

P: No.

D: OK. Alright, thanks Jessica. So just to summarize, you kind of had a three to four day dry cough with a little bit of fever, some headache, and just in terms was quickly reviewing then. So you have been bringing anything up. No one in contact with these recently been sick. You don't have asthma, your not taking any medications aside from Claritin, and your little brother might have been sick about two weeks ago with kind of a common cold and we're hoping to get out of this visit is just kind of next steps and where to go from here, correct?

P: Yeah, like, I just want to know if I have to like take medicine or something.

D: OK. Alright perfect Thank you very much. You have any more questions?

P: No, I don't know. I don't have any more questions. I just like I can go home soon like lay down.

D: Sounds good, thanks Jessica.


D: What brings you in?

P: I've had a cough that started like 4 days ago, um and it's just been getting worse, so I I wanted to come in.

D: OK yeah, it's good that you've come in. Um, so the cough started four days ago, has it been constant since?

P: Yes it has.

D: OK, and how often are you coughing?

P: I um, I'd say a few times an hour now. Uh when it first started, it was a bit more intermittent, but now it's happening um all day long and throughout the night as well, it interrupted my sleep last night.

D: Oh OK, um is it a dry cough or are you producing sputum?

P: It's it's mostly dry.

D: OK, so no sputum, no blood?

P: No blood.

D: OK. Um do you find that there are any triggers to your, to this cough, like um, environmental triggers, like the cold weather, um any old carpets at home, or um you know a particular time of the day, or exertion, anything like that?

P: No, interestingly, nothing like that seems to really make it worse. It's just been um kinda coughing all day.

D: OK, and um has anything made it better? Have you tried anything for this cough?

P: Uh I tried um drinking some uh like tea and some other cough syrups and it didn't didn't help.

D: OK, um how about, ah, OK. And if you were to describe the quality of this cough, would you say it's it's, it sounds barky, it sounds harsh, um how would you describe it?

P: Uh harsh.

D: Harsh, OK. And if you were to rate your symptoms 1 to 10, 10 being the worst, how bad is it?

P: Uh, 6.

D: Six, OK. And and have you found that your symptoms are getting worse, staying the same, or getting better over the past four days?

P: Getting worse.

D: Getting worse, OK. And have you ever experienced anything like this in the past?

P: Uh no.

D: No, do you feel wheezy at all?

P: No, I haven't heard any any wheezes.

D: OK, how about uh shortness of breath?

P: Yeah, I've definitely noticed some difficulty breathing, um yeah.

D: OK, and uh, when when did, when did your shortness of breath start?

P: Right around the same time as the cough or maybe shortly after, um yeah, shortly after.

D: Shortly after, OK. Do you find that there are any triggers for shortness of breath, like exertion?

P: Yeah, yeah exertion. Um as well as like the cough itself, I'm finding that I'm coughing so much throughout the day that I'm having a hard time catching up and catching my breath afterwards.

D: Yeah, for sure. Um OK, and any chest pain?

P: No chest pain.

D: OK. Um How about feeling like your heart's racing?

P: No, nothing like that.

D: No, any swelling in your legs or arms?

P: No.

D: OK. Do you ever feel like you have uh pain in your calves after walking um a few blocks?

P: No.

D: No, any fainting spells or dizziness?

P: Uh, no.

D: No, um have you had a sore throat?

P: No.

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

P: No.

D: Runny nose or stuffy nose?

P: Not, no, but I've definitely, I feel like I've maybe noticed a change in my smell.

D: OK, how so?

P: I just uh, I feel like I haven't been able to smell as well.

D: Um when did you notice that?

P: The, really, these last like 2 days.

D: OK, and any changes in your taste?

P: Uh I haven't really I, I thought, well, I wasn't really able to taste my food, but I thought that was because I couldn't, I wasn't smelling, um so I thought that was just going to go away, but the symptoms have gotten worse.

D: Yeah, and have you had a fever or chills in the past few days?

P: Uh yeah, I've had a fever um or I felt hot anyway.

D: Did you take your temperature?

P: I haven't checked it, but um like I've been feeling pretty sweaty from how hot I've been.

D: OK um so we'll take your temperature today and we'll let you know. Um have you noticed any weight loss over the past few weeks?

P: No.

D: No weight loss, how about fatigue or muscle aches?

P: Uh maybe these past couple of days, yeah.

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

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

D: OK. Um any changes to your bowel habits?

P: Uh, no.

D: No, any nausea or vomiting?

P: Um, no, no.

D: No, OK. Any abdominal pains?

P: No.

D: Any changes to your urine?

P: No.

D: Uh confusion or memory loss?

P: No.

D: OK, and would you say that you are an otherwise healthy person?

P: Yeah, yeah, that's why, these symptoms um really surprised me.

D: Yeah, um so you've never been hospitalized or needed surgery in the past?

P: No, I haven't needed to, I haven't seen a doctor in a few years.

D: OK, um, are you on any medications?

P: Uh nope, just uh take a multivitamin and uh, and that's about it.

D: OK, um, OK, um any allergies?

P: Uh yeah, I'm allergic to um cats.

D: Cats, OK. And have you been around any cats recently?

P: No.

D: No, OK. How about immunizations? Are you up to date?

P: Yeah I am.

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

P: Uh, no.

D: How about cancers?

P: Nothing like that.

D: OK, and do you smoke?

P: No.

D: Um how about marijuana?

P: Uh sometimes I'll have a joint with friends or something like that on the weekend, but um yeah, so maybe once a week.

D: Once a week, OK. Um, how about alcohol, do you drink any alcohol?

P: Uh, no

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

P: I live in a house um with my wife and uh 3 kids.

D: OK. Is anyone else sick at home?

P: Uh everybody's been well.

D: OK, um any reason to believe that you've been around any sick contacts recently?

P: Um possibly, um I mean, I'm in sales, so meeting with clients all day, um maybe one of them were sick.

D: Yeah, yeah for sure. Um, any travel recently?

P: Uh no travel, all the meetings have been in the city.

D: OK, OK good. So those were all the questions that I had for you today. Did you have any questions of your own or anything that you wanted to discuss today that I missed?

P: Um no, that, I was just worried about uh Covid.

D: Yeah, so that's definitely top on the list right now for things that we have to rule you out for. Um so we'll take a swab today, we'll send it off um for those PCR results, you should hear back in 24 to 48 hours. Uh in the meantime, you should isolate for 14 days, and that includes from family members when possible, and public health will get in touch with you if those results are positive and so they can they can do some contact tracing. If it's not Covid, it could be another viral illness that's going around, and I guess the best therapy for that is staying hydrated, um getting good sleep, and eating nutritious foods. Uh but if your symptoms get worse, like you're running a really high fever, um you're having neurological symptoms like you know seizures or fainting spells, um or if you're having difficulty breathing, um you should come back to the ER. So how does that sound?

P: Yeah, it's really informative. Thank you.

D: Alright, take care.

P: Thank you.


D: How can I uh, help you today?

P: Hi, so I just came in today because I've been just been feeling um, like my head's just been hurting for the past three or four days and I also felt really cold throughout the day for the last few days as well, so, um, I did end up checking my temperature just yesterday afternoon and it was um, 38.7 degrees celsius.

D: Okay, um. Tell me about the headache, where exactly is it?

P: Yeah so it's kind of just throughout like the front of my forehead and it kind of goes to the side into my temple.

D: And what does it feel like?

P: It feels like a constant aching. I've had uh, migraines before, but they like, it's not like the pulsating sensation that I usually get with them.

D: I see. Uh, okay, and how severe is the pain, if you had to rate it from 1 to 10?

P: Um, more than like severe. It's definitely less severe than my migraines, but it, it's just constant. It's, it's just been there for the last four days and I would say probably a 6 out of 10.

D: Did you do anything for the pain? Did you take any medications? Anything that makes it better?

P: Yeah, I took a Tylenol, I took um, Advil. It helps for like a few hours and then it just comes back.

D: And anything that makes the pain worse?

P: Um, I definitely think just, if I rest, it's better if, but if I'm like, like I can't, I can't concentrate on work or like anything.

D: Okay. Um, and other than the, um, the fever and headaches, have you um, had any um, cough?

P: No, no cough.

D: Runny nose or congestion?

P: No.

D: Sore throat?

P: No, not really.

D: Changes in your sense of smell?

P: Uh, I do actually feel like I, like I am losing my smell today.

D: And sense of taste?

P: I just had breakfast today so um, breakfast was okay. I didn't, uh, but yeah, definitely sense of smell.

D: Okay, and any difficulties breathing?

P: No.

D: Okay, any chest pain?

P: No.

D: Um, do you feel like your heart is racing?

P: No.

D: Any diarrhea or constipation?

P: No.

D: Nausea or vomiting?

P: No.

D: Pain in your belly?

P: No.

D: Any muscle aches or joint pains?

P: Uh, no, nothing like that.

D: Okay, um, do you feel like your neck is stiff?

P: No.

D: Any numbness or tingling in your arms or fingers, or toes?

P: No.

D: Any um, night sweats or weight loss, unintentional?

P: No, I've only been gaining weight.

D: Okay. Any fluid in your, any sort of, swelling in your legs?

P: No, nothing like that really.

D: Okay, um, any medical conditions that you've been diagnosed with?

P: Yes, so I have uh, type 2 diabetes. I was just recently started on metformin medication.

D: When were you started on metformin?

P: So I think around uh, it's been around two months.

D: Okay, how is that going for you? Are you tolerating it okay?

P: Yeah I've, I've been tolerating it well. It's just they, they said like I'm kind of just on the edge of the diabetes, like my level, so they just want to act, um, proactively.

D: Yeah, that's good. Um, any other medical conditions?

P: No, that's, that's all.

D: Any medications other than metformin that you take? Anything over the counter?

P: Um, so I do take, when my migraines get bad, like I do take, I have taken naproxen before.

D: Okay. Surgeries?

P: Uh, no surgeries.

D: Hospitalizations?

P: Uh no.

D: Okay, any allergies to medications, foods, or any environmental allergies?

P: Not to any medications, but I do have an allergy to peanuts.

D: Okay, what happens?

P: I do get like a, an anaphylactic reaction.

D: Okay, okay. Um, and any um, family history of any medical conditions?

P: Uh, so on my dad's side, they like all, like all the men seem to have diabetes, so it's good that I'm starting on the medication. Um on my mom's side, they're pretty healthy. I don't think my mom has any medical conditions.

D: Okay, good. Um, and do you currently live alone or do you live with other people?

P: Yeah, so I live with my wife, I live with my two kids, a son and daughter.

D: And um, have you or any of them had any exposures to anyone who could possibly be sick?

P: Um just, uh, so my wife is a school teacher, um, and they did have in-person. Just uh, she's a high school teacher, and they had some they have in-person classes. So yeah, I don't know, but she's been feeling well. My kids are feeling well too.

D: Okay, and have you traveled anywhere outside the province?

P: No.

D: Okay, and do you currently smoke or did you ever smoke in the past?

P: No, I've never smoked. I do smoke marijuana just, maybe once or twice a month with some friends.

D: Okay, any recreational drugs?

P: Sorry, no.

D: Um, any alcohol?

P: Yeah, I probably drink um, a couple of beers during the weekend.

D: Okay, got it. Um, alright. Well, given your symptoms, um, we would like to do a COVID swab, just in, or request a COVID swab to be done through public health, um, just to, just to rule it out. Your symptoms do sound like, or overlap with some of the symptoms that are seen in patients who do have COVID. It could be that you have um, just um, just I guess like your headache and fever. Um, I'll also like do a physical exam to see there's nothing else going on. But in the meantime, I, I'd like you to self isolate and stay away from the rest of your family members as well, um, at least until the results are out. And then when the results are out, if it's positive, you'll receive more guidelines from public health as to what you need to do.

P: Okay, sounds good, um, and I work from home, so I don't need to.

D: Oh that's good. Okay, so you work from home.

P: Alright.

D: Good.

P: Thank you.


D: And what brings you to the emergency department today?

P: Low back pain.

D: OK, and where exactly is uh is the back pain?

P: So the pain's just right in the in the lower back.

D: Just in the lower back, OK. And when did this pain start?

P: It started yesterday, I was unloading groceries from my pickup truck when it suddenly started.

D: OK, so, and, did you kind of make any kind of movement? Or did you pick up something really heavy?

P: I'm not sure. I just noticed the pain after um after that.

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

P: It feels like it's stabbing just right in my lower back.

D: OK. And, um, on a scale of 1 to 10, uh 1 being like the least pain that you felt in your life, 10 being the worst, how much would you rate this pain?

P: If I'm sitting, uh completely still like like I am right now, it's a 2 out of 10.

D: OK. Um and when does it get worse?

P: Uh anytime I I move or bend my back or uh even cough it it worsens the pain significantly.

D: OK, and has this pain changed at all since yesterday?

P: No, it's been this same awful pain this whole time.

D: OK and have have you ever had this kind of pain before?

P: I've had back pain uh over the years, but nothing like this before.

D: OK. And does it, does the pain go anywhere or does it just stay in the lower back?

P: I also feel the pain uh into my right leg.

D: OK, and is it the same kind of aching or like stabbing pain that goes into your right leg? Or is it uh just like an aching pain?

P: Uh it's it's a, uh, an aching pain.

D: OK. And do you have any other symptoms besides the pain? Like are you experiencing any kind of weakness or any kind of, any other changes in your health?

P: Uh no it's just the uh the low back pain.

D: OK, and have you ever uh experienced any kind of trauma to your back? Like something has hit you or you've fall down, anything like that?

P: No, I can't remember any injuries like that in the past.

D: OK, any uh fevers or chills or night sweats?

P: Um no fever, uh no chills, no night sweats.

D: OK, any uh symptoms of feeling very tired, fatigued, anything like that?

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

D: OK. Any changes to your skin at all? Uh I mean, any rashes?

P: No.

D: OK, any pain in your joints at all?

P: Uh just the back pain.

D: OK. Uh any new coughs or any um symptoms and runny nose or anything like that?

P: Uh no.

D: Any changes in your um bowel movements at all like diarrhea, constipation or anything?

P: Nothing like that, been regular.

D: OK, how about, uh, any urinary problems?

P: Uh no, nothing to report there.

D: OK, and how has your appetite been?

P: Uh appetite's been normal.

D: Any significant weight loss or weight gain recently?

P: No, the weight's been about the same.

D: OK, any recent infections that you know of?

P: No, I've been feeling well otherwise.

D: OK. Any uh tingling sensation or numbness uh in your back or lower limbs, in your legs?

P: Uh no numbness or tingling.

D: OK. Any muscle weakness at all?

P: Uh no muscle weakness.

D: OK, have you been uh having any uh kind of erectile dysfunction?

P: Uh no concerns with uh erectile dysfunction.

D: OK, and any issues with uh incontinence, like uh having accidents at all, at night or during the day?

P: Uh no, I haven't had any problems with bowel or bladder incontinence.

D: OK, alright, and in terms of your past medical history, have you have you been diagnosed with any conditions like high blood pressure, diabetes?

P: Uh type 2 diabetes.

D: OK, and do you take any medications for it?

P: Uh I, um insulin for diabetes.

D: OK, and any other medications at all?

P: Uh just been taking Tylenol for the the back pain.

D: And has that worked for you at all? Or has it not made a difference?

P: Uh maybe it's taking the edge off a little bit, but it hasn't done too much uh to help the pain.

D: OK, any allergies?

P: Uh nope.

D: OK. Any previous surgeries?

P: Uh I had hemorrhoids removed three years ago.

D: OK. Um any hospitalizations before?

P: Uh no, it was just day surgery,

D: OK, any family history of any um conditions uh or like any cancers?

P: Uh my father had prostate cancer.

D: OK. And currently right now, uh do you work?

P: Uh I'm a retired school teacher.

D: OK, and where do you live?

P: I live alone um in a in a house uh not too far from here, actually.

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

P: Um occasionally uh maybe I'll have a glass of red wine on the weekend or something like that, but uh not too often.

D: OK, and do you smoke?

P: Uh, I've smoked um yeah, I smoke a pack of cigarettes uh per day.

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

P: Uh about 40 years.

D: 40 years, OK. And, uh, do you use any kind of recreational drugs?

P: Uh never.

D: OK, and how is your diet like on like a regular basis?

P: I feel like it's uh pretty normal, mostly home cooked meals with some variety, vegetable, vegetables, other meats, and fish. I would say it's pretty balanced.

D: OK, alright, I just have a few more questions for you. Um are you currently sexually active?

P: Yes, I am.

D: OK and who are you sexually active with, any new partners at all?

P: Uh no new partners, um just my girlfriend, uh.

D: And, uh, how many, I'm sorry, go ahead.

P: Um just my my girlfriend recently.

D: OK, and have you been sexually active with more than one partner in the past, past year?

P: Uh yes, I have, um um two women over the past year.

D: OK, and um do you use any kind of protection?

P: Yes, always use uh condoms.

D: OK. Alright, so now I'm just going to get the patient's vitals.


D: What brings you in?

P: Hi, yes I just came in today because I've been a bit concerned about some breathing difficulties over the last few days. It all started out with like a cough over the last week, but now I'm having trouble breathing as well.

D: Oh OK, well I'm sorry to hear that. So you said a cough as well, so the cough at least a week back and the shortness of breath or difficulty breathing, when did that start?

P: So yeah, the cough, I usually have a cough. I've had COPD for a long time, but this past week the coughing has been much worse with a lot of more sputum and. Other than that, it started I would say two to three days ago. The cough got worse and then every time I'm moving around I like have to sit down and catch my breath, which is pretty abnormal for me.

D: OK yeah, so alright. So let's focus on the cough first. You said it's a wet cough?

P: Yes, I am producing a lot of sputum.

D: OK, what color is your sputum?

P: It's mainly like clear white.

D: OK yeah so you don't see yellow pus or anything green or bloody in there?

P: No, I don't think so. But there's definitely like a lot more than what I usually produce.

D: OK, umm this cough, does it sound harsh, barky or does it sound muffled?

P: I would say it's a bit harsh at times. I wouldn't say it's barky or muffled. I do find myself wheezing a little over the last few days as well.

D: OK. Do you find you have any chest pain associated with the shortness of breath?

P: Oh no, I don't really have any pains.

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

P: I did a couple of years ago, I had to be admitted because I had some shortness of breath.

D: OK.

P: But that was, I think, two years ago.

D: OK. And when you were admitted two years ago, did they tell you what you had?

P: Yeah, they said I had some kind of lung infection at that time, so they gave me some antibiotics while I was in the hospital.

D: OK, did they ever say to you that you had anything else like asthma, COPD, any longstanding conditions?

P: Yeah so I've had COPD for more than... I guess more than 10 years now so I think it just got a lot worse with the infection.

D: OK yeah alright. So this time around, have you had any fevers?

P: I've been having a couple of chills but like they would come and go. I didn't really think it was a fever.

D: OK, any weight loss?

P: No.

D: OK, how about changes in your hair or nails like or or skin like rashes?

P: Umm, no.

D: Any changes in your vision or hearing?

P: Nope.

D: And how about smell or taste?

P: Umm, no. I think they're the same.

D: OK. Have a stuffy nose or runny nose?

P: I do feel a bit stuffy, but it's not too bad.

D: OK. And any swelling in your in your legs or upper limbs?

P: No, not that I know.

D: How about calf pain?

P: Nope.

D: Dizziness or fainting spells?

P: No.

D: Headaches?

P: No headaches.

D: Memory loss or confusion?

P: Nope.

D: Changes in your bowel movement or abdominal pain?

P: Nope.

D: Changes to urinating?

P: No, that's all fine

D: OK, so besides the COPD, do you have any other longstanding conditions?

P: I do have some high blood pressure which I take, I think I take one of these medications called metoprolol.

D: OK, and when was the last time you had your blood pressure checked?

P: Umm, probably like a month ago and it was pretty good. I've been checking by myself at home too and it hasn't been changing too much. I think the last one I took was probably like 135 / 80.

D: Oh, I see. OK, any hospitalizations besides the one that you had for COPD a year back?

P: Umm, back when I was a kid I had my tonsils removed.

D: OK, are you on any medications besides the metoprolol?

P: I do take multivitamins.I think that's yeah, that's about it.

D: Do you take any puffers for your COPD?

P: Yeah, so I do have three like different puffers I take. I can't remember the name. I do have some puffers I don't take. I've been using them right now. It has been helping with some of my shortness of breath, but I've definitely been having to use them way more than I used to.

D: OK. Do you know which puffer you're on?

P: Yeah, so I think one of them is called ventolin. OK, and then I think the second one is called the Spiriva.

D: OK, sure, Yep.

P: So one of them should be a short acting beta agonist.

D: Just wanna make sure that you have one with a long acting and then the other one is a long acting beta agonist. OK, good. Alright, are you up to date with all your immunizations?

P: Yeah, I think so.

D: And are you allergic to anything?

P: No, not that I know.

D: Any family history of lung conditions?

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

D: OK. How about heart conditions?

P: Yeah, my father died of a heart attack in his 60s.

D: OK. Alright, any cancers?

P: My uncle had skin cancer.

D: OK. Do you know what type of skin cancer like melanoma, basal cell, squamous cell?

P: No, I think it wasn't the bad one. It was like the one they can remove right away.

D: Oh I see. OK, OK, that's good.Do you smoke?

P: Yeah, I've been smoking for around, I would say the last 20 years.

D: OK, how much do you smoke?

P: Probably I would say pack a day for the last 20 years.

D: Umm, have you ever thought about quitting?

P: Yeah I did. I did once and then went back onto it. I definitely do smoke less than before though. OK, but yeah, I don't think I'm ready to quit yet.

D: OK, yeah no problem. Do you drink alcohol?

P: Umm, yeah, maybe once a week I would have a small Cup of whiskey.

D: OK, sure, that's fine. And any other drugs?

P: No, no marijuana, no other drugs.

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

P: Right now I live in a small bungalow in London.

D: OK, any reasons to believe there are carpets, dust, mold, asbestos, anything that could be triggering your COPD?

P: Umm, I don't think so. Everything is pretty up to date.

D: OK, have you had any contact with anyone that's been sick recently?

P: No, I've been mostly trying to isolate and like just be in my own home.

D: OK, how about travel to anywhere?

P: Nope, I've been in Ontario since the beginning of the pandemic.

D: Yeah OK, that makes sense. Well, those were all the questions that I had for you today. Did you have any questions of your own?

P: Yeah, I was just worried if it can be COVID or if it's just like another infection that I had like before.

D: Yeah, so we're definitely going to do a COVID swab on you and those results should take about 24 to 48 hours to come back to you. And in the meantime, because your symptoms do overlap with COVID, you should isolate for 14 days. Public health will be in touch with you if it's positive to do some contact tracing. If it's not COVID, it could be another viral infection that's been going around during this time of year which is likely because you have COPD, since you're already coughing more than you usually are and seeing more sputum. We will reassess to see whether your puffers are working. If we need to add any additional things like inhaled corticosteroids as well as antibiotics and so just keep an eye on your symptoms for now and will also want to do probably a chest X Ray and possibly a pulmonary function test. How does that sound?

P: Thank you.

D: OK yeah no problem.


D: What brings you in?

P: Hi there, I've been having this uhm, cough that's been ongoing for the past two days, and I've started to become short of breath as well. Even with just a little bit of exertion. I've also been feeling feverish and I checked my temperature and it was 38 point, uh, point 5.

D: OK, Well that's definitely a fever. Can you tell me a little bit about when the coughing started?

P: Yeah, I first noticed it two days ago and it's been kind of just getting a little bit worse over these last two days to the point now where I'm I'm short of breath as well.

D: OK, so that's sort of two days ago and then when do the shortness of breath start?

P: Uh, the shortness of breath has been within the last day within the last day.

D: Within the last day, OK. And the coughing is that I dry cough or is it a wet cough?

P: It's a dry cough.

D: OK. Uhm so no sputum or blood.

P: No sputum or blood in the coughing.

D: OK, that's good. And alright any chest pain?

P: No, I haven't had any chest pain.

D: OK. Any palpitations of your heart?

P: No, no heart palpitations.

D: OK. And any have you noticed, like a runny nose or a stuffy nose?

P: No, I haven't really had a runny nose, no runny nose.

D: OK, no runny nose. That's good, and then any changes in your vision or hearing?

P: No changes to vision or hearing.

D: How about changes to your smell or taste?

P: No changes to smell or taste. That's been been normal.

D: Been normal, OK, that's good. And how about of, how about weight loss?

P: No, I haven't had any, uh, any weight loss.

D: OK, that's good, any rashes?

P: Uh, no rashes.

D: Changes to your bowel movements?

P: No, I I haven't had any. No diarrhea. I have had a little bit of uh like belly pain though.

D: OK, OK. When did the belly pain start?

P: That's just been uh, yeah, within the last day, uh, as well. It just feels a bit uncomfortable kind of all over.

D: OK yeah alright uhm and you don't feel gassy or, or bloated?

P: No.

D: OK. Uhm, and no nausea or vomiting?

P: No, I haven't had any. Ah, actually I have been a bit, I've had some nausea as well like that's what I feel like with that with the abdominal pain.

D: Mhmm. OK, And any changes in your smell or taste?

P: Uhm, so I, actually yeah, with the sense of smell like I haven't been able to smell as well. Now that you ask again, yeah, sorry.

D: OK, no worries and any appetite changes?

P: Yeah, I haven't. I've had a loss of appetite.

D: OK. Alright. Alright, and are you still eating the same or a little bit less?

P: A bit less. So I guess I haven't been is hungry. I say similar amount of time just really these last two days.

D: Yeah. Have you had any dizziness or fainting spells?

P: No, I haven't.

D: No. Any memory loss or confusion?

P: No.

D: No. Joint aches or muscle aches?

P: Yeah, I've had like muscle aches. I guess I feel like we've been getting older, but no yeah, I've had muscle aches these last couple of days as well. Kind of generally achy.

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

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

D: OK.

P: Yeah, my weights a bit a bit high.

D: OK, uhm and do you take any medications for these things?

P: Yeah, so I take metformin and I also take an ACE inhibitor, and that's it.

D: OK. Alright, and are you up to date with your immunizations?

P: I believe so yes.

D: Yeah. OK. And how about allergies? Do you have any?

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

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

P: Uh, no, nothing like that.

D: OK, uhm, alright, any history of like cancers in the family?

P: No history of cancer in the family.

D: OK. Do you smoke at all?

P: No, not I don't smoke.

D: You don't smoke, OK. How about recreational drugs?

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

D: No. OK. Do you drink alcohol?

P: Yeah, I'll have like one beer each day so yeah, about yeah, one beer a day.

D: One beer a day, OK. And where do you live right now?

P: Umm, so I live in a house with with my wife and ah, and our son.

D: OK, and anyone at home sick?

P: Uh, nobody's been sick at home.

D: OK, have you been in contact with anyone who has been sick?

P: Uh, I don't think so. I mean, I've been going out to do the essentials and uhm, I I do work out at a factory ah and so I mean, there might have been somebody there, but I'm not sure.

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

P: Uh no travel, just been going to work and doing the essentials and home.

D: OK, that's good. And any reasons to believe you have old carpet, mold, asbestos, pets, anything at home that could be making your condition worse?

P: I don't believe so. No, we yeah, it's a new a newer home and we've done some renovations.

D: OK, that's good. Uhm those are all the questions that I had for you today. Did you have any questions of your own for myself?

P: No, I was just worried that maybe I could have Covid.

D: Yeah, for sure, so that's kind of top on my list right now to rule out, so we will do a Covid swab and you should hear back in about 24 to 48 hours with those results. In the meantime, you should isolate for for about 14 days and if your symptoms get worse, go to the ER and if you're experiencing things like weakness, seizures like, and you're not getting any better in a couple of weeks, or you feel dehydrated. Otherwise, supportive care at home, keeping yourself hydrated, eating well, sleeping well, all of those will definitely help as well. Does that sound OK?

P: Yeah, it does. Thank you.

D: OK, yeah, no problem.


D: What brings you here today?

P: I've had this like, pain in my knee. It started within the last few hours and my knee's swollen, it's painful. Um, I can barely move it.

D: Okay, were you uh, did you injure yourself at all before the last few hours or anything? Any trauma to um, is it the right knee or the left knee?

P: It's the left knee, an no, no trauma uh, or anything like that. I've never hurt this knee before in my life.

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

P: Uh. Um, no, nothing in my joints. I've had other infections before, like in my skin, um, like cellulitis, but I, I've never had a knee, knee problem like this before.

D: Okay, I see. And have you ever had cellulitis in that area?

P: Uh, I, I had it over, kind of my, uh, like over my foot before.

D: Okay, and um, where would you describe the pain is? Is it like on the kneecap, is it above the kneecap, below? Where would you describe it?

P: I would say it's like my whole knee, it's like uh, I don't know, it looks like it's going to explode.

D: Okay, is it like um, so, it's swollen, is it red and warm?

P: It is, yeah, it's really red.

D: Okay

P: And warm as well.

D: Okay, and how would you describe the pain? Um, is it like a sharp, stabbing pain, or is it an aching pain?

P: It's a, a stabbing pain.

D: Okay, and uh, are you mainly having the pain with movement of your knee, or um, when you're pressing on it?

P: Uh, I would say both, I can't um, I can't really move it, it'll give me pain. And even pressing on it, it's, it's quite painful.

D: Okay. And on a scale of uh, 1 to 10, sorry 0 to 10, with 10 being the worst pain you've felt in your life, how much would you rate this pain?

P: Uh, it's a 9.

D: A 9, okay. Um, so it just started a few hours ago. Is there anything that makes the pain better or worse?

P: Um, I mean just trying to stay as still as possible is all I've been been doing so far, uh because, um, like any type of movement is really bad.

D: Okay, and are you able to weight bear, are you able to stand and walk by yourself?

P: Uh, I, I was pretty much like hopping on one leg to, to get in here and as soon as I could, I got in a wheelchair, just because it uh, hurts so bad.

D: Okay, and um, do you have any pain or symptoms in any other joints or muscles of your body?

P: No, just, it's just my left knee.

D: Just your left knee, okay. Um, do you have any other symptoms like fevers, chills, nausea or vomiting?

P: Um, I have felt uh, uh feverish, yeah. But then, yeah, I, I felt feverish and um, but I haven't had any chills, though.

D: Okay, when were you feeling fevers?

P: Uh, just like, today, it's kind of, yeah, it started within the last day.

D: Okay, and um, did you get a chance to measure your temperature at all? If not, we can do that here.

P: Um no, no, I didn't get to uh, I, I didn't check it.

D: Okay, and have you been sick at all recently, either with um, any cold-like symptoms uh, or any GI symptoms, like diarrhea, um, constipation, anything like that?

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

D: Okay, and have you recently had any um, sexually transmitted diseases, or exposures to uh, ticks or lyme disease?

P: Uh, I don't think so. I've been just, in well, in the city. I haven't traveled anywhere, and I uh, I haven't been sexually active for, for quite a while now, so.

D: Okay, okay. Uh, have you recently, at all, had um, any procedures done on your knee, like any surgeries or any joint like um, injections or aspirations?

P: No, nothing done to my knee.

D: Okay. Okay, um, so yeah, we'll take a temperature of your uh, fever, and, so are you able to flex or extend your knee at all, or is it very painful?

P: It's really painful. I uh, the movement's really limited.

D: Okay, and has the pain been constant since it started a few hours ago.

P: Yeah, it's gotten uh, like it's, it's gotten slightly worse.

D: Okay, I see. Okay, um, any skin changes or rashes anywhere on your body?

P: No, it's just the red knee.

D: Okay. Um, any changes in your weight or appetite?

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

D: Okay, and otherwise, are you having um, any symptoms of uh, dizziness, fainting?

P: Uh, no, I haven't had any of those symptoms.

D: Okay, any weakness um, in your extremities?

P: No, no weakness.

D: Okay, um, do you have any past medical conditions that you've been diagnosed with? Any diabetes? High blood pressure?

P: Uh, I've been told my, my blood sugar has been like, it hasn't been controlled, so yeah, I think I have diabetes. Um, uh, but that's, that's it.

D: Okay, um, do you take anything for medicate, medication for your diabetes?

P: Uh, yeah, I, I take metformin and um, and uh, yeah, that, that's all I've been taking, but, I mean, it's really hard for me to uh, like get my medication sometimes and so um, I don't always take it.

D: Okay, I see. Um, and do you have any allergies to any medications?

P: Uh, not that I, not that I can think of. And, so something that I forgot to mention is uh, like I've had hepatitis in the past as well um, and uh, yeah.

D: And do you know hepatitis you've had?

P: Um, I've had, it was uh, hepatitis C and uh, I was, um, treated, I was treated for it.

D: Okay. Okay, and how long ago was that?

P: That was about uh, two years ago.

D: Okay, and uh, did they tell you like how it may have been transmitted at all? Was it, uh, sexually? Um, was it through um, use of IV drug use? And did they tell you what the likely cause was?

P; Yeah, the, the likely cause was um, I was told it was through IV uh, drug use. I've been using now for uh, for about 10 years.

D: Okay, and have you um, and what do you usually use?

P: Uh, well like, any, anything that I, that I can usually. But I, I guess like um, various types of opioids are kind of the, the, the main thing that I'll, that I'll use.

D: Okay, and have you um, injected uh, drugs recently at all?

P: Uh, yeah I, about uh, about two days ago was the last time.

D: Okay, okay. And um, do you use any other uh, drugs? Any recreational drugs like marijuana or any, do you inject any other drugs at all?

P: Yeah, I'll smoke, uh, smoke marijuana as well and um, like, I'll sometimes like, I'll take uh, pills too like dilaudid is um, is something that I'll, I'll get my hands on, but it can be expensive so, um, just, just whatever is available.

D: Okay. Um, have you had uh, when was the last time you had cellulitis?

P: Uh, he last time was about six months ago.

D: Okay, and were you admitted at all, or were you treated as an outpatient?

P: Uh, I was treated as an outpatient for that, and it did clear up. It wasn't the first time that I've, I've had cellulitis and, and um, yeah, so it was treated.

D: Okay, have you had any hospitalizations or surgeries in the past?

P: Um no, I haven't.

D: Okay. Uh, any family history of any conditions um, musculoskeletal or rheumatologic conditions? Uh, any rheumatoid arthritis, anything like that?

P: Uh, I don't think so.

D: Okay. And currently, right now, um, what is your living situation like?

P: Uh, so um, I just live with uh, two of my, um, or actually sorry no, I live with my uh, with my parents and uh, yeah, so it's just both my parents.

D: Okay. And, um, do you currently work?

P: Uh, I was working until like, I um, yeah about uh, about 15 years ago and now I, like I got injured on the, uh, um at work and I've had like chronic back pain and I don't know, I think that's kind of how this partly all, all started. So I've been at home receiving uh, I'm on disability.

D: Okay. And do you smoke cigarettes?

P: Uh, I do, yeah I, I, I smoke um, about half a pack uh, to a pack a day.

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

P: Uh, so this has been, uh, about 20 years.

D: 20 years, okay. And do you drink alcohol?

P: Um, sometimes yeah. I'll, I'll have uh, just a few beers, maybe a few beers a week.

D: Okay, and yeah, we were just talking about some of uh, like the movement, but you're saying you have pain with any kind of movement at all, right?

P: Yeah, it, it's really painful, I just, I try not to move it at all.

D: And it's very red and swollen and warm as well?

P: Yeah, all of those.

D: Any symptoms at all in your hips or ankle?

P: No, those feel fine. I can move my hip and ankle okay, and no pain.

D: Okay, alright, so those are all the questions I had for you. We'll do like a full physical examination, take a look at your knee, um, and most likely, what this sounds like, is something called septic arthritis. It's uh, it's when there's like an infection that um, can go into your joints and uh, it is a pretty serious issue that we need to um, assess and treat as soon as possible. So the first thing that we will um, need to do, we'll need to do some blood work just to get some inflammation markers and just your uh, CBC, and see if you have um, an infection. However, we'll also need to do a joint aspiration of your of your um, go your knee, and we'll be taking some fluid within your joint called the synovial fluid and assess for um, we'll send in for um, culture, and look for like these crystals, and count. And then based on that, we'll understand um, the infection you have and what kind of infection you have. We will start you on antibiotics right away um, today, and so you will be um, here for a while until we get all those results back. And you may also require um, an admission today as well.

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

D: Alright, yeah, so yeah, we'll get all that done for you shortly, and uh, we'll go from there.

P: Right, thank you.

D: And um, we might also need an x-ray, so just sit tight. We'll, we'll come call you.

P: Okay, thank you.

D: Alright, you're welcome.


D: Uh, how may I help you?

P: I've, uh, had a runny nose over the last few days and I've started to have a sore throat as well.

D: Hmm, Uhm, when did this start?

P: I would, so the runny nose started, uh, about five days ago and, and the sore throat, uhm, about the same.

D: OK. Have you, uh, with the, the runny nose, do you have any, what's the discharge like?

P: Uh, it's been kind of watery, it's clear.

D: OK. Alright and has your sore throat gotten better or worse over the past five days?

P: Uh, it did get a little bit worse initially and since then it's been kind of stable.

D: Have you, uhm, had any difficulties swallowing?

P: No, it, it is a bit sore, uhm, to swallow so it takes me a little bit longer to eat, but I've been able to still, still eat.

D: Have you changed, noticed any changes in your voice? Any hoarseness in your voice?

P: No.

D: No, OK. And do you have any nasal congestion? Does your nose feel stuffy?

P: Yeah it does, yes.

D: OK, uhm, any fevers or chills?

P: No, I don't think so.

D: OK. Any difficulties breathing?

P: No.

D: Any cough?

P: No.

D: OK, uhm any, uh, pain in your chest?

P: No.

D: Any other symptoms, anything related to your belly,  say, diarrhea or Constipation or any changes in your urinary, any urinary symptoms?

P: No, nothing like that.

D: OK, OK, are you feeling fatigued, tired? Have any muscle aches?

P: I, I have felt a little bit more drowsy these last few days and, uhm, yeah my, uhm, I have had some muscle aches as well.

D: Have you taken anything to help yourself, anything over the counter or any pills?

P: I did use, uh, some uhm, like cold medication to help because I was having a headache as well and a lot of I guess just like pressure from the nose stuffiness.

D: Did the cold meds help?

P: Yeah, it did help a little bit, it did help my nose clear up but it came right back after a few hours.

D: And how's your headache now?

P: It's not too bad. It's pretty mild, but it's there.

D: Uhm, do you usually get headaches of this sort, or is this very different from what you generally experience, if you usually have headaches.

P: I don't usually get headaches, but I have felt uhm, a headache like this before though.

D: Oh OK, when was that?

P: Maybe the last time I was, I was sick.

D: Sure.

P: Or if I don't get a good night's sleep. School's pretty early in the morning, so sometimes if I'm not sleeping well.

D: I see. OK alright, any other symptoms that you've experienced over the past five days that I didn't ask you about?

P: No, it's been, yeah mostly the runny nose and sore throat and headache.

D: I see. OK, alright, and do you have any medical conditions?

P: No, I've been healthy.

D: All right, good, any medications that you take on a regular basis?

P: Uh, I'll use like Reactine or Claritin sometimes for allergies, but that's it.

D: What allergies do you have?

P: I have allergies to dust and some environmental things, like pollen or ragweed I think maybe.

D: I see. Alright, and, uhm, do you have any family history of any medical conditions?

P: Uh, I think my dad has high blood pressure. He takes a medication for that, uhm nothing serious though that I know of.

D: OK, alright, and who do you currently live with?

P: So I live with both my parents and I have an older sister as well.

D: Good, OK, and do you smoke?

P: I did try a vape once or twice, but, didn't really like it so, no.

D: Alright, what about marijuana?

P: Uh, no, I haven't tried that.

D: Any recreational drugs?

P: No.

D: Do you drink alcohol?

P: No.

D: And have you recently traveled anywhere?

P: No, we've been doing classes virtually.

D: And any contact with anyone who you think might be sick.

P: No.

D: OK alright, well sounds like you have a sore throat and runny nose. You've been a little bit drowsy, had some headaches in the past five days, things were getting a little bit worse early on, but it's been a little bit, it's been more stable now. We'll do a physical exam, see, just listen to your chest, have a look inside your mouth and check your temperature and go from there. It sounds like you probably have a viral infection of some sort that should get, hopefully get better over time. We will also get a covid swab done just in case and if things seem to get worse, we can, you can definitely come back.

P: OK, great, thank you.


D: Umm, how may I help you?

P: So yeah I've been having for the last two days, uh, it just started randomly. I had to miss work, Just a headache started at the beginning and then I noticed the same day, so this was two days ago. A headache started and my body just started aching throughout the day and yesterday I just developed, I think it was a fever, I didn't really get a chance to check, like, but I was very chilly yesterday and now I have this cough as well.

D: OK, so just to confirm, so the, the symptoms at first started with a headache and, and fatigue, and that started two days ago?

P: Yeah, like with fatigue, like also just the, my muscles were aching.

D: OK, and any particular muscles that were achy or is this more of a, uhm, general kind of whole body feeling?

P: Just a general whole body feeling.

D: OK. Uh, and in terms of the headache, could you describe, uhm, could you describe the headache?

P: Yes, it's just kind of like at the front like near my forehead, on, on kind of like both sides more. It just feels like, like pressure in there.

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

P: Uh, no, not really.

D: OK. Uhm, is the headache on one side or, or the other or on both sides?

P: I think it's like both sides.

D: And is the headache like pulsating or is it more, continuous kind of constant pain?

P: I think it's more continuous constant.

D: Alright, and have you had any sensitivity to light or sound that, that's made the headache a lot worse?

P: No, it's, it's kind of just there, it's about the same as when it was when it started.

D: OK, have you had any nausea and vomiting associated with that, the headache or anything else?

P: Uh, no.

D: OK. And so, and then, last question for the headache piece. Does it feel like it was a like kind of sudden onset, worst headache of your life sensation?

P: Uh, no, it's still like, like I can still cope with it, like, if I wanted to I would have gone into work. But it was the muscle aches that really started bothering me.

D: OK. And so you had a cough as well, when did this start, and is it a dry or wet cough?

P: It's a dry cough and it started yesterday, probably in the morning when I woke up.

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

P: Uhm, since yesterday I would sayit's probably a bit worse now.

D: Alright, and it's dry, but have you seen any blood that's come up?

P: No, no, no blood.

D: And have you had any shortness of breath?

P: No.

D: OK. And have you had any flu like symptoms or infectious symptoms like a red eyes, runny eyes, runny nose, or a sore throat?

P: No, I don't have any of those symptoms.

D: OK, you mentioned you felt feverish. Do you feel hot now?

P: Not right now, but I did have, last night just, was just very chilly and Uh, I had to just wrap myself up in a couple blankets.

D: OK. Did you have any night sweats?

P: No, I, I didn't have any night sweats.

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

P: No, no chest pain.

D: Alright, so how about any dizziness or lightheadedness?

P: Nope.

D: OK. And have you had any wheeze?

P: No wheezing.

D: OK. Uhm, and have you noticed any swelling to any of your extremities? Like your ankles?

P: Uh, no. Nope.

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

P: No belly pain.

D: Any urinary problems like pain or, or frequency going to the bathroom?

P: No.

D: And any diarrhea?

P: No diarrhea.

D: Alright, and have you noticed any rashes or, or changes to your skin?

P: No, not at all.

D: Alright, and I don't know, you've had muscle aches, have you had any joint pains?

P: Uh, no, no musc, sorry no joint pain. It's mainly just like in, I would say in around my upper back like my upper arms and kind of like my thighs and glutes areas

D: OK. And how has your energy been these last couple of days?

P: Yesterday I felt a bit drained. I just kind of like stayed in bed the whole day.

D: OK, and have you tried any medications for the, for the headache or any of your symptoms so far?

P: I, I took a Tylenol. I actually took a couple Tylenols, uh, when the headache and pain started. It did help a bit for a couple hours, but it just kind of came back.

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

P: Uhm, Just uh, like I had type 2 diabetes, that's it.

D: OK, and are you using medications for your diabetes?

P: Yeah, I've been on Metformin.

D: OK, have you used insulin before?

P: No, no, I've never had to use insulin. It's pretty stable, like my family doctors even considering taking me off the metformin.

D: OK, no, that's great. And that reminds me, actually, how has your weight been over the last several months? Have you had any weight changes?

P: Not really, like I, I, I think over the last two years I've just been very focused on my fitness, so I feel like I've probably lost around 30 pounds over the last year. Last one to two, yeah, year, but like I, I've been exercising a lot like uhm, gym every day, it's, it's been, it's been a journey.

D: no that's great though, good for you. I encourage you to keep that up for sure. OK, and so do you take any other medications, other, over the counter or prescribed?

P: Uhm, just a multi vitamins.

D: Alright, and do you have any allergies to medications?

P: No, not that I know of.

D: All right. So have you had any hospitalizations or surgeries?

P: No.

D: Alright, and uh, anybody in the family have any like lung conditions, heart conditions or diseases that run in the family?

P: Uh, my, my son actually just recently was diagnosed with asthma. But I think that he gets that from his mom's side.

D: OK. Uhm, you don't have any asthma or problems breathing like that?

P: No, nothing like that.

D: OK, and right now, so you mentioned your son and wife, is that who you're living with?

P: Yeah, it's just us three.

D: OK, and uh, any exposures to, to anybody who's been sick, either at home or at work or, or any other activities?

P:  Uh, unfortunately I do have to, uh, I'm one of the unlucky ones that still has to go into work. And yeah, it's it's hard to say like at work, there are times when we, like at lunch we eat like without a mask. I don't know if, I didn't notice anyone having any symptoms, but like, I don't know if someone, you know, who knows where anyone has been.

D: Yeah, so nobody that you're aware of who's been sick though?

P: No.

D: And everybody at home has been OK?

P: Yeah, at home everyone's good. I kind of just distance myself into like one room.

D: Mhm.

P: Just in case anything goes wrong.

D: OK. And have you traveled anywhere?

P: No, we've been, we've been at home this whole time.

D: OK. And do you smoke cigarettes?

P: No, I've never smoked.

D: OK, so do you, do you smoke marijuana?

P: No.

D: Alright and you use any other recreational drugs like cocaine, opioids, heroin? And how, have you used anything like that in the past?

P: No. Never.

D: OK, uhm, and do you drink alcohol?

P: Yeah, well just occasionally, like I would say maybe, maybe some wine, once, uh, like once every couple days. Maybe a beer on the weekend, but that's it.

D: Alright. So I think that was all I wanted to ask on history today. Was there anything else that, that you wanted to add before we go on to the exam and?

P: Yeah, so I, I, I don't know if I should get a test done, like for covid. Uhm yeah, that's all, just wondering if I, if I can do that here?

D: Yeah, so that is something that that is on the differential for what could be causing your symptoms, especially with uhm, starting at having a cough and the nonspecific viral type symptoms with the cough, headache, muscle aches, so certainly could be caused by covid, but there are other reasons for, that could explain these symptoms, such as other types of viral illnesses, and so we will do a PCR swab today, as well as do, well, check your vitals to see if you have a fever now and we'll also maybe send an influenza swab as well, and and do some blood work. But in the meantime, since we're running the covid swab, it will be important to self isolate for the next 14 days and we will let you know what the test results show. But despite, even if they are negative, it will be important to still stay self isolating for the next 14 days.

P: OK, I'll do that. That sounds good.

D: Alright, thank you.


D: Could you tell me what brought you in today?

P: Sure, you know I've been having this chest pain for the since last night. Um, and I'm also having a hard time breathing so thought I should check it out.

D: Ok, um and so the chest pain came on last night. Were you doing anything before before it coming on?

P: No, I was just about to head to bed and suddenly I felt this crampy pain in my chest.

D: Ok, and where is this pain located?

P: I'd say like the center of my chest.

D: Ok, uh, has the pain been going on constantly since last night?

P: Yeah, I would say so.

D: Ok, has it changed in character at all? You said it was crampy, but has it felt like anything else?

P: Um, no. Just just crampy, yeah.

D: I see, did you feel the pain anywhere else, or do you feel it just in the center of your chest?

P: Ah yes, center of my chest going up to around my throat area maybe.

D: OK, I see and anything that you've done, that's made the pain worse?

P: Um, I guess taking in a deep breath.

D: Ok, and how about changing positions, does the pain get worse if you lie flat or or if you lean forward?

P: No.

D: Ok, um, and have you ever had a pain like this in your chest before?

P: No.

D: Ok, and and has the pain get been getting worse, getting better, staying the same?

P: It's been the same.

D: Ok, have you taken anything for it, to help with the pain?

P: No.

D: Ok, and the shortness of breath you mentioned, uh, when did that start?

P: Around the same time.

D: Ok and, is this trouble breathing like after walking a certain distance or exerting yourself?

P: No, it it it, it's just always there.

D: Ok, and have you noticed any changes to the sounds of your breathing, like a wheeze or whistling sound?

P: Yeah, maybe maybe a slight wheeze.

D: Ok, do you think that you're breathing more quickly?

P: No.

D: Ok um, have you had a cough?

P: No cough, no.

D: Alright, and so you haven't been bringing up any sputum or or any blood?

P: No.

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

P: No sore throat.

D: Alright, so you've had this chest pain since last night and shortness of breath that started around a similar time last night. Have you had any other symptoms?

P: Just just some fatigue, some tiredness.

D: Alright, and did that start around the same time?

P: That started a few days before, like maybe two days before.

D: Ok, has there been any change to your sleep or any stressful events happen that might be tiring you out?

P: No.

D: Ok, and have you had any headaches?

P: Nope, no headaches.

D: How about any eye symptoms like discharge or or eye pain?

P: No, nothing like that.

D: Any any redness of your eye?

P: Nope.

D: Alright, so have you had a runny nose?

P: No.

D: Alright, and uh have you felt like your heart is racing at all?

P: No.

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

P: Nope.

D: And have you had a decrease in your appetite?

P: Um, no.

D: I see, ok and have you had any changes to your weight in the last several months?

P: No.

D: Alright and, have you had any diarrhea or constipation?

P: No.

D: Alright, and how about any nausea or vomiting?

P: Uh, none.

D: Any abdominal pains?

P: No.

D: Alright, and how about any confusion or or concerns around memory?

P: No.

D: Alright, and, any muscle aches or pains?

P: Maybe slight muscle aches.

D: Have you had any weakness?

P: No.

D: Ok, and any rashes you noticed anywhere?

P: No none.

D: Ok, and have you had a fever?

P: Um, nope.

D: How about any any chills?

P: No chills.

D: Alright and then any night sweats?

P: No.

D: Alright, and do you have any medical conditions that you see a physician regularly for?

P: No, actually sorry, I have diabetes.

D: Ok, is that type 2?

P: Type 2.

D: Ok, and are you taking any medications for that or is it kind of diet or lifestyle controlled?

P: I'm on insulin for that.

D: Ok, and you use a sliding scale or do you have a regimen you use?

P: Um, I have, so I have like a long acting and short acting, so I just take the long acting before I go to bed and then the short acting before meals.

D: I see ok. So that sounds like a great, a great plan. Do you take any other medications?

P: Yes, I take some vitamins and you know, like vitamin D and calcium, but that's it.

D: Ok, any allergies?

P: I'm allergic to penicillin.

D: Ok, have you had antibiotics recently for any reason?

P: No.

D: Ok, and are your immunizations up to date?

P: I think so. I think the only thing is I have to see if I'm up to date with my Pneumovax.

D: Ok, great yeah I was wondering about that one so we can look into that certainly. And do you know if you've had the Zoster or the Shingles vaccine?

P: Yes, I had that one.

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

P: Sure, I live with my husband. We live in a 3 bedroom townhouse. It's a fairly new home.

D: Ok, great. Did you recently move there?

P: Yes we did.

D: Ok, cool. And so there's no concerns with like old carpets or being exposed to kind of like dust or or molds or anything like that in the home?

P: No, nothing like that.

D: Ok, and um, has your husband been sick at all?

P: No, he's been fine.

D: Ok, and do you have any pets in the home?

P: We have a cat.

D: OK, and do you have any allergies to pets?

P: No.

D: Alright, um and how do you support yourself financially right now?

P: Um, we're both retired, but we have our RESP savings.

D: Oh excellent, ok, and for your previous occupation, were you exposed to any chemicals or like asbestos or inhalants that you're aware of?

P: Uh no no, nothing like that.

D: Ok, and you smoke cigarettes?

P: I don't.

D: Do you drink alcohol?

P: I have maybe a glass or two glasses of wine over the weekends.

D: Ok, and do you smoke marijuana or use any cannabis products?

P: No, I don't.

D: OK, and how about the use of any other recreational drugs?

P: No, no, nothing like that.

D: Ok and, and has anybody in your family had a heart condition before?

P: My mother passed away when she was 80, she had some valvular issues.

D: Ok um, uh, ok, and has anybody in the family had a heart attack before?

P: No, not that I know of.

D: Alright, and, anybody have any lung conditions?

P: No.

D: Alright, and then any cancer that runs in the family?

P: Cancer? No no.

D: Ok um, I think that's all I wanted to cover on the the history today. Was there anything else you'd like to tell me that I was, that I maybe didn't ask about?

P: Uh no, I think you asked me all those other questions, I'm just wondering what do you like, what do you think I have?

D: Yeah, certainly, uh, so it could possibly be something related to the heart. I don't, and sometimes especially people in your age group who have diabetes can have chest pain and symptoms that could be nonspecific. And so we will, we will check that for sure. We'll get an ECG and some lab work with the troponin and also a chest X Ray so that we can investigate for that. And also the chest X Ray could help us look to see if you have something going on in your lungs, like a possible pneumonia or, maybe a viral infection as well, which could include something like COVID-19. So we'll be ordering a PCR nasal swab as well to test for that. And so in the meantime, because we'll be doing that test, it requires self quarantine for 14 days so, if possible, that would mean distancing from your husband in the home as well for that 14 day period, but the results should come back from that test within the next several days. And and sorry, also if it is positive, we will have to notify public health as well so that the appropriate contact tracing can be done.

P: Ok, ok well thank you very much.

D: Now you're very welcome. We'll get the investigations started now.

P: Sure, sounds good.


D: What brings you in?

P: Hi, yeah, so I've had this uh back pain that's been going on now for the last uh two weeks, it's just kind of right in the lower back and it just hasn't gone away.

D: OK, um last two weeks you said, is it getting worse?

P: Uh no, it's not really getting any worse, uh it's just been uh limiting my abilities at work.

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

P: So I work um at a butcher shop.

D: OK.

P: Yeah, and we're like always like carrying heavy things and yeah, it's a lot a lot of like lifting and standing.

D: OK. Did anything trigger this back pain two weeks ago? Did you have some sort of injury or trauma to the area?

P: No, I can't think of anything uh like specific that happened, but there was one night where um like after work, I was sitting down after dinner and um I got pretty stiff that night. It was pretty sore and kind of ever since then, it's been been sore.

D: OK, OK, um and is this a persistent kind of back pain or does it come and go?

P: It's um, I can kind of always feel it, but it certainly gets worse if I am moving. So if I'm just kind of sitting at rest, I don't really, yeah, I don't really feel it that much.

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

P: I'd say I get kind of uh, it's a sharp pain.

D: Sharp pain, OK. Um does anything make it better or worse?

P: Um better would just be uh resting.

D: OK.

P: Um kind of just lying down, or um yeah, just just trying to uh rest. But um making it worse, yeah, if I'm uh like really any movement um if I'm like bending forward or um kind of like leaning to the side, I start to get um get some pain in the lower back.

D: OK, OK. And then 1 to 10, 10 being the worst pain you've ever felt, how bad or uh how severe would you rate it?

P: I would say 7.

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

P: Uh yeah, I've I've hurt my lower back before like many years ago. Um but it's been OK since then.

D: OK. Uh did you get any sort of treatment or management for that pain um back in the day?

P: At that time it was just rest and like did some stretching and I took some um anti inflammatories and it went away after a couple of months.

D: OK, OK. Um and are you having any sort of like numbness or tingling, anywhere on your body?

P: No, nothing like that.

D: Alright, how about any muscle weakness?

P: Uh no muscle weakness.

D: No, OK. Are you still able to walk and do things that you normally would do in a day?

P: Uh yeah, I'm able to walk still.

D: OK. Um any dizziness or fainting spells?

P: Nope, nothing like that.

D: OK. Any pain elsewhere on your body?

P: No, just just the lower back, yeah.

D: OK. Headaches?

P: Uh nope.

D: OK, weight loss?

P: No, I haven't had any weight loss.

D: OK. Fevers or chills?

P: Nope, no fevers or chills.

D: Um rashes?

P: Uh no rashes.

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

P: No changes like that.

D: OK. Any coughing, shortness of breath or wheeziness?

P: Um nope, nothing like that.

D: Um chest pain or heart palpitations?

P: Nope, nothing like that.

D: OK. Issues or changes in your bowel movements?

P: Uh no changes to bowel movements, no diarrhea and no incontinence or anything like that.

D: OK, um and then uh nausea or vomiting?

P: Nope, nothing like that.

D: OK, how about um changes to your appetite?

P: Um nope, I've been eating uh, I've been eating well.

D: Changes in your voiding?

P: Uh nope, I haven't had any changes to urination.

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

P: Uh I I've had a few sports injuries when I was younger, uh like to my my knee, but that's it, I've been healthy otherwise.

D: OK and um those injuries, are they all healed?

P: Uh sometimes I'll get um like a little achiness in my knee from from doing like too much activity, but I know when those, when that happens.

D: OK. Are you on any medications?

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

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

P: I am, yep.

D: OK. Um do you have any allergies?

P: Uh, no allergies.

D: OK, any family history of um muscular or skeletal issues?

P: Um no, nothing like that.

D: OK, how about um heart or lung diseases?

P: Uh, no, no heart or lung diseases.

D: OK, uhm how about autoimmune conditions?

P: Um nope, nothing like that.

D: OK. Cancers?

P: Uh no cancers.

D: OK. Um and do you smoke?

P: Um no, I don't smoke.

D: OK and do you consume marijuana?

P: Uh sometimes, I'll have like uh edibles, little candy, sometimes at nighttime they they help me uh relax and sleep, but I don't use that very often.

D: OK, how often do you use them?

P: I would say maybe uh once a week.

D: Once a week, OK. Alright um and then, what else did I wanna ask you? Um do you, do you take any recreational drugs?

P: No, and I haven't used any before.

D: OK, and how about alcohol, do you consume alcohol?

P: Yeah I'll have a couple of beers on the weekend, so maybe like two or three.

D: OK, uhm and who and where do you live right, who with and where do you live right now?

P: Yeah, I live with my wife and our um and our son who's in high school. We live in a in a house.

D: OK, OK. Um alright, and any concerns for STI's at all?

P: Oh no, I've been with my wife now for a long time and we've been monogamous so no concerns for uh sexually transmitted infection right now.

D: OK, how about um sick contacts, have you been in contact with anyone sick recently?

P: No, I don't think so.

D: OK, any travel recently?

P: Uh no, I haven't traveled anywhere.

D: OK um and well, let's move on to the physical exam part of this interview. Um so I'm going to get you to stand up from a sitting position. Does that hurt your back?

P: Um yeah it does. I I do feel a little bit of a a twinge there.

D: OK, and where about specifically?

P: Kind of just, yeah, on the lower uh lower right side like more on the, more on the right side.

D: More on the right side, OK. Now, if you have a mirror with you, or if you have someone there with you who can um speak to this, does your right side appear more red, swollen, or hot compared to your left side of the lower back?

P: Uh no, nothing like that.

D: No, OK, and does it seem like it's more atrophied or do you see any deformities or skin changes in that area?

P: Uh nope, no deformities or skin changes.

D: OK, um alright and I'm gonna get you to um bend down all the way and touch your toes if you can.

P: Um yeah I I can get part part way down.

D: You can get partway down, does it hurt?

P: Um a little bit, I can feel it pulling and stretching, yeah.

D: OK. Um alright, and then I'm gonna get you to uh like laterally flex to your right side. So kind of like you're doing an exercise um and you're just like bending towards that side.

P: Yeah, that hurts.

D: That hurts, OK, how about the other side, the left side?

P: Yeah that hurts too.

D: OK. Um and now I wanna get you to uh bring your knees up towards the ceiling. Does that hurt? One at a time, like your right right knee and your left knee.

P: Uh, not really.

D: No, OK, how about when you um flex your knees backwards?

P: Nope.

D: And kind of point your knees towards the ground.

P: No, no pain there.

D: OK, so no pain on knee extension or flexion. Um how about when you point your toes to the ceiling?

P: Uh no pain there.

D: OK so no pain on plantar flexion, how about when you point your uh toes to the ground?

P: No pain there.

D: OK, so no pain on dorsiflexion, and then sorry I forgot to ask you earlier, do you have any sort of numbness in the groin area?

P: No, no numbness in the groin area.

D: OK, so no numbness in the groin area, no weakness, no um changes in your bowel or bladder habits, including no incontinence, so uh no red flags?

P: Yeah, nothing like that.

D: OK, OK, good um and, OK so those are all the questions that I had for you. Did you have any questions for myself?

P: Uh, no I was just uh yeah, kind of wondering do I do I need any X Rays or like what what what's going on?

D: Yeah, so um what it sounds like right now is that you have something called mechanical back pain. It's pretty common and um it can be anything from your spinal joints to the discs to the vertebrate or soft tissue or muscle. Um and a lot of these can be caused by um hard activity at work, um like carrying heavy things um and then carrying them in like an improper position or something like that. Um and we diagnose that on history and physical exam, um but if after we try some management and treatment plans, it doesn't go away and it persists for more than eight weeks, we do recommend imaging, including an MRI. So uh in terms of management for right now, um modified activity at work, um some short term bed rest, uh very short term though um and bed rest is only really recommended if you have severe back pain and muscle spasms, um and you definitely shouldn't be doing that for more than like 24 to 48 hours, and physical activity can help, um so referral to physical therapy or physiotherapy um can help in rehab and they'll give you some exercises that you can try at home to kind of um strengthen those muscles. And then ice and heating packs um temporarily can help, uh medications like NSAIDs can help as well with the inflammation. Um so we'll try these things out and then we'll continue to follow up. Um yeah, did you have any questions or does that sound like an OK plan?

P: Uh that sounds like a good plan.

D: OK, sounds good, thank you.


D: What brings you in?

P: I I've had this, uh pain in the right buttock area, it's been really intense, and more recently I'm feeling it like radiate just down my right leg as well.

D: OK, and sorry when did you say it started?

P: So um it's been going on uh for, well, it's it's gotten really intense in the last uh like 2 days.

D: OK, and before that, did you have any pain at all or was it just like sudden?

P: Yeah, I do have a bit of pain uh down in my uh in in my buttock area. Um but um it's just gotten really uh, it's gotten more painful over these last couple of days.

D: OK. Um and is it a persistent kind of pain? Or does it come and go?

P: Um it's uh persistent, it's it it does get worse though, depending on what what I'm doing.

D: OK, what uh when does it get worse?

P: Um well it it gets it gets worse with walking, with sitting, um really any like any kinds of movements, like if I just gotta kind of stay still and that's the only thing that really helps it.

D: OK, um have you tried anything for it?

P: Uh yeah, I'm just taking some pain medic medications over the counter for these last couple of days um like Advil and Tylenol, but that's it.

D: OK, um and does, is it helping?

P: It does, I mean, uh not really, it hasn't really helped much.

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

P: Uh it um, kind of like a sharp pain in the in the buttock and um it it um it's kind of like burning uh down the leg.

D: OK, OK, so a radicular kind of pain then. Um OK, and if you were to rate the severity of your pain 1 to 10, 10 being the worst pain you've ever felt, what would you rate it?

P: 8.

D: OK. And does this pain radiate elsewhere, I know you said it starts on your buttocks, kind of goes down your legs, does it go up your back or down into the other leg at all?

P: No, I feel it just uh just in the buttock and down the leg.

D: OK, uh have you ever experienced this kind of pain before?

P: Uhm I have, yeah um I'm a a truck driver, and so I do a lot of uh a lot of sitting and I've had kind of sciatic pain um in the past.

D: OK, and have you ever had any like trauma or anything that could have triggered this initially um in the past?

P: No, I don't think so, I don't, I haven't really done much, just kind of work and um ueah, I haven't had any trauma to the back or anything like that.

D: OK, and are you experiencing any sort of weakness with your legs?

P: Uh no no weakness, just um well, yeah, maybe I guess, maybe yeah, maybe a little bit of uh, leg weakness, I've had I've had a little bit of difficulty walking, been limping.

D: Oh I see, OK. OK, and just in your right leg, right?

P: Yeah.

D: Any urinary or um stool incontinence?

P No.

D: No, OK. Any sexual dysfunction?

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

D: OK, um any numbness or tingling?

P: Yeah, I've I've had some numbness and tingling down the the right leg.

D: OK, how about in the groin area?

P: No, it's just kind of down the back of my leg.

D: OK, um alright, and otherwise do you have any other symptoms?

P: No, it's just been just been, uh, this pain.

D: OK, alright. Um and I'll just kind of go through some questions with you. Do you have any joint pains or muscle aches elsewhere?

P: No.

D: No weight loss?

P: No weight loss.

D: Fevers or chills?

P: No fevers or chills.

D: Uh rashes?

P: No rashes.

D: Changes to your vision, hearing, smell, or taste?

P: No.

D: Um are you coughing, having shortness of breath, or wheezing?

P: No, I haven't been any, having any symptoms like that.

D: OK, any chest pain, palpitations, uh or dizziness or fainting spells?

P: No, nothing like that.

D: Any changes to your bowel movements?

P: No diarrhea or constipation.

D: And no bleeding in the stool?

P: No blood in the stool.

D: OK. And then how about nausea or vomiting?

P: No, I haven't had any nausea or vomiting.

D: OK, changes to your urine?

P: Uh no, no changes to the urine.

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

P: I do have um high blood pressure and uh high cholesterol and I take medications for those, I take amlodipine and um a statin.

D: OK, do you have any other medical conditions, are are you on any other medications besides those?

P: Just a multivitamin.

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

P: I am, yes.

D: OK, any allergies?

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

D: No, uh family history of um musculoskeletal or neurological issues?

P: Uh no, nothing like that.

D: Uh autoimmune conditions?

P: No, nothing like that.

D: Cancers?

P: No.

D: No, OK. And do you smoke?

P: Um yeah, I smoke uh about um half a pack of cigarettes per day.

D: OK, for how long have you been doing that?

P: Uh for uh yeah, about 40 years.

D: 40 years, OK, have you ever thought of quitting?

P: I have, yeah, I've cut down over the years, um I used to smoke more, it's just the culture with uh, I don't know everybody's driving a truck and smoking.

D: OK, yeah, that's hard. If you ever need any resources, we have some that we can refer you to.

P: Thank you.

D: Yeah, no worries. And do you um consume marijuana?

P: No, I don't.

D: OK, how about other recreational drugs?

P: Uh nope, nothing like that before.

D: OK, do you drink alcohol?

P: Um yeah, I'll have a beer or two on the weekend, so maybe a couple of drinks per week.

D: OK. Um and how about um do uh, sick contacts, have you been in touch with any recently?

P: No, I haven't been around anybody who's been sick.

D: OK, um any travel recently?

P: Uh just for the drop offs that I that I make um driving, I do have to make some pretty um long hauls uh back and forth um, the, yeah.

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

P: So I live in a house with my um with my wife uh yeah and son.

D: OK, alright and, OK so now I'm just going to move on to the physical exam part of this um and I'm going to ask you to do a few things, OK? So, well just by looking at your legs, or if you have a mirror um and you can look at your right buttock area, um do you see any swelling or redness?

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

D: OK. And does it feel hot?

P: No, it doesn't feel hot.

D: OK. And do you see any skin changes?

P: No skin changes.

D: Um any atrophy or deformity in the area?

P: No.

D: No, um has your gait changed, like does it, are you limping, hobbling, anything like that?

P: Um yeah, I feel like I've been limping a little bit, uh yeah.

D: Are you putting more um pressure on the left foot then?

P: I am, yeah, yeah, I guess there's like an antalgic gait.

D: OK, alright, and then um if you press down on your hipbone, do you feel any pain there? On your right hip bone.

P: No, I don't.

D: OK, how about when you press down on your buttocks itself?

P: Um yeah, there is uh a little bit of tenderness um over the buttock area.

D: OK, how about the back of your legs?

P: No.

D: OK, how about the front um of your legs, thighs?

P: No.

D: No, OK. Alright, um and then I'm gonna just get you to do a few movements um with me as well. Would you uh OK, so are you sitting down right now?

P: Yeah.

D: OK. Would you mind standing up from a sitting position?

P: Yeah, for sure.

D: Does that hurt?

P: It uh yeah, that that that causes pain.

D: OK, so that causes, so um hip hip extension uh that causes some pain, um and as well as knee extension, so would you mind um kicking your right leg up in front of you all the way up as far as you can go?

P: Mhmm, oh yeah.

D: Does that hurt?

P: It does, yeah.

D: OK so right hip flexion um also causes pain, and then would you mind uh folding your knees backwards um and just sort of flexing it? Does that hurt?

P: Uh no.

D: OK, so no pain at knee flexion. And how about when you point your feet um and toes up towards the ceiling?

P: Uhm yeah I I do get some pain with my um, yeah when that's all straightened out, yeah.

D: OK, so some pain on um planter flexion of the right foot. And how about if you um point your feet and toes towards the ground?

P: No pain there.

D: OK, um alright and how about when you uh kick your legs uh to the side and upwards?

P: Oh uh no pain with abduction.

D: OK so no pain on right hip abduction, and then how about when you bring it back down?

P: No.

D: OK and no pain on hip adduction. OK, well those are all the questions that I have for you. Do you have any questions for myself?

P: Uh just wondering about possibly like what it could be.

D: Yeah, um so it sounds um right now like you may have some sort of uh sacral nerve radiculopathy um or or like a lower lumbar, lumbar um radiculopathy, um basically uh that's known as sciatica, uh where your nerve roots can be compressed, causing some of these symptoms. Um and to diagnose these things, usually it's just done by history and physical exam um but if after we try out some management things, it doesn't go away or you're having some red flags, including um numbness in the groin area, bowel or bladder incontinence, then we can look at some um imaging for the for the spine, including MRI. Um and so in terms of management of this, um we can try a couple couple of like conservative approaches first, so that includes taking NSAIDs uh for the pain um and then like activity modification. So if you're sitting down um all the time, um perhaps like taking little breaks, uh stretching out your legs, doing some physio as well um during those breaks can help um, and as well, I'm going to give you a referral for physical therapy and they'll do some exercises with you and um slowly increase those exercises. Um and if those still don't work, we can try um steroids, steroid injections, um as well, we talked about the imaging if it doesn't go away in about 6 to 8 weeks. Does that sound OK?

P: Yeah, that sounds good. Thank you.

D: OK, yeah no problem.


D: So what brings you in here today?

P: Hi, um so I've been very I've been, I haven't been feeling very well for the past four days. I've, I've been having chills. I am feeling short of breath and now my chest hurts.

D: Okay, I'm sorry. Um so how long, like can you just tell me what started first and when did this all kind of start?

P: So, what started first? So, I would say the shortness of breath started first, um, and then I started having these chills and now it hurts like my chest hurts every time I try to take, try to take a deep breath in.

D: And how long is this been going on for?

P: Um, it's been going on for the past four days.

D: Four days, okay. Um, and do you have any kind of cough at all?

P: No cough.

D: Okay, so just shortness of breath. And can you describe your shortness of breath a little bit? Is it uh, are you having catching your breath, or would you say you're having trouble taking deep breaths? Or how would you describe it?

P: It's mostly when I'm trying to take a deep breath in.

D: Okay, and uh, where would you say you're getting the chest pain?

P: Um, it's mostly like centre of my chest, like, close to my, like I'd say it's like it feels like, it's not my like, it doesn't feel like it's inside. It feels more like it's pushing up on, on my chest wall.

D: Okay, I see. And is it related to you taking deep breaths at all?

P: Yes, it's definitely when I take a deep breath in.

D: Okay, and what kind of pain is it? Is it like a sharp pain, stabbing pain, aching pain? How would you describe it?

P: Um, it's a, it's, it's like a, I don't know. I guess it's a sharp pain when I try to take a deep breath in.

D: Okay, um, and does it get relieved with uh, when you when you expire?

P: Yeah.

D: Okay, and have you had any of these symptoms before in the past?

P: Um, nothing like this.

D: Okay. Um, would you say like, your symptoms are constant, or do they kind of come and go?

P: Um, they're pretty constant.

D: Okay. And are they getting worse at all?

P: Uh, no it's not getting worse, it was just bad to start with and it's still bad.

D: Okay, and um, is there anything that you've tried that helps you with your breathing or relieves your chest pain? Anything that works for you?

P: Um I guess sitting forward helps. Time now to take a super deep breath in.

D: Okay, and have you had any kind of fevers or chills?

P: Uh, yeah, I've, I've had chills for sure. I felt hot. I haven't actually taken my temperature, so I'm not too sure about if I actually have a fever.

D: Okay, and when did you feel these chills?

P: They've been going on for the past three days.

D: Okay. Uh, and do you have any kind of other symptoms, like runny nose, sore throat, anything like that?

P: Uh maybe like a slight runny nose, yeah.

D: Okay, and do you get short of breath when laying down at all?

P: Um, I, no, not no, I wouldn't say so.

D: Okay, and do you have to wake up at night to catch your breath at all?

P: No, nothing like that.

D: Okay, and do you have any kind of swelling in your legs, hands, anywhere?

P: No.

D: Okay. Have you experienced any kind of um dizziness or fainting episodes?

P: Uh, no.

D: Okay, do you get any kind of chest pain with any activities?

P: No, not really. I guess it's, I get tired with the shortness of breath.

D: And do you, um, find that your heart is racing at all?

P: Uh no, nothing like that.

D: Are you having any night sweats?

P: No.

D: Um, have you had any sick contacts recently?

P: Uh, I guess when I went to the grocery store the other day and there were people coughing around me.

D: Okay, and were they wearing masks or were you wearing a mask?

P: Yeah, everyone was wearing a mask.

D: Okay. Are you um, having any kind of changes in your bowel movements at all? Any constipation or diarrhea?

P: No.

D: No, okay. Any changes in your appetite at all?

P: Uh, no.

D: No. Any nausea or vomiting?

P: No.

D: Okay. Any changes in your urinary pattern?

P: No.

D: Okay, any changes in your weight recently? Have you lost any significant weight?

P: No.

D: No, okay. Have you recently had a cold, like cold-like symptoms at all within the last few weeks?

P: Um, yeah, I guess the runny nose. Um, I've had on and off for the past like 7 days.

D: Okay, now, it hasn't gone away?

P: No, it's not that bothersome though. It's more the chills and the shortness of breath, and this chest pain now that is worrying me.

D: Okay, and do you have any past medical conditions or diagnoses?

P: Um I was diagnosed with diabetes, um high blood pressure and high cholesterol.

D: Okay, and when were you diagnosed with diabetes?

P: I was diagnosed about 10 years ago.

D: Okay. Um, I'm sorry I forgot to ask you this specifically, have you experienced any kind of loss of your sense of taste or smell?

P: No.

D: No, okay. Um do you take any medications for your medical conditions?

P: Um, medications. So I take, so, for the diabetes I take insulin. For the high blood pressure I take ramipril. For the high cholesterol I take rosuvastatin.

D: Okay, and do you have any allergies to any medications at all?

P: No.

D: Okay. Um, any recent surgeries or hospitalizations? Or any reason for why, if like, if you were immobilized at all?

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

D: Okay, any history of hospitalizations or surgeries at all?

P: Uh, I had a cholecystectomy about, oh gosh, it's like, 12 years ago.

D: Okay, and were there any complications at all?

P: No.

D: Okay. Um any family history of any lung conditions, heart conditions or cancers?

P: No.

D: Okay. Um currently, do you work at all?

P: No I, no I'm retired.

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

P: I live with my husband, um in a condo.

D: Okay. Um and are you, is your husband well? Does he have any symptoms?

P: Uh yeah, he's, he's been okay.

D: Okay, that's good. Um, any kind of dust or mold, asbestos or any pets in your in your home?

P: No, nothing like that.

D: Okay. Do you smoke at all?

P: Um I used to, but not anymore.

D: Okay, and how long did you smoke for and how much would you smoke everyday?

P: Uh, so I stopped about 20 years back. I smoked for about 25 years. I smoked about a pack a day.

D: I see, um, and do you use any recreational drugs like marijuana?

P: Um, I don't, no.

D: Okay, and do you drink alcohol at all?

P: I, I'll have a glass of wine here and there.

D: Okay, and um yeah, so those were kind of, all the questions that I had today. Do you have any concerns or questions?

P: Um, yeah like what, do you think I have COVID?

D: Yeah so, right now it's definitely something that's on everyone's mind. Um some of these symptoms, um the shortness of breath and fever, definitely can be COVID, and that's something that we are going to test you with, and that's something we test everyone with. Um, but because you're having shortness of breath, uh, we do need to make sure nothing else is going on as well. Uh you can potentially have pneumonia that's not COVID, it can be any other virus or bacteria, so we will get some blood work done, we'll get your temperature and all your vitals taken as well, um and then get a chest x-ray as well.

P: Okay.

D: And if it turns out at all that you have pneumonia, we'll just reassess and see if you need to stay in the hospital for longer, if you need any antibiotics within the hospital, or you can take them at home. So yeah, we'll do a full physical examination and do all those tests and then go from there.

P: Okay, that sounds great. Thank you.

D: You're welcome. Um yeah, we'll be there with you shortly.

P: Okay, great.