D: What brings you in? 

P: Yeah, I've had uh, a cough that's been um, bugging me for the last several months now, and more recently I've noticed that I've started to bring up a bit more, or a little bit of blood as well.

D: Okay, well that's not good. So you said the cough started several months ago, how many months ago do you think, like three, four, five?

P: Uh, yeah I would say, yeah, maybe like, like five or six, and it kind of started um, it was really infrequent and so it didn't really, well I thought it was just the usual smoking, but it's been getting worse over these last, over these past six months.

D: Okay and um, the blood in the cough, when did that start?

P: So that started about, uh, about two weeks ago.

D: Two weeks ago, okay. Um, how much blood are you coughing up like, if uh, like is it the size of your palm, is it more than that, less than that?

P: Uh, I would say less than that, like each time there's maybe to about the size of I don't know, uh, like a looney. So like inside of the palm.

D: Okay, sure. Um, and are you experiencing any shortness of breath along with your cough?

P: Yeah, now that you mention it, I have been. It's uh, you know, I thought that was just kind of me getting older and the smoking, but I've certainly been able, I haven't been able to walk as far and even uh, to the end of the driveway getting the mail now is, is pretty, I'll get short of breath. Before I used to be able to walk a lot further than that, just a couple of years ago.

D: Yeah, for sure. Um, and sorry you said, you mentioned, you mentioned you had some wheezing as well, right?

P: Um, I haven't really had any, noticed any wheezing.

D: No, okay. Um, and have you had a fever recently? 

P: No. 

D: Weight loss?

P: Um yeah, now that you mention it, maybe, maybe a little bit, like 5 to 10 pounds over the last, the last month.

D: Last month, okay. Um, any chills, fever, sorry, chills, or night sweats?

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

D: Okay, any rashes?

P: No.

D: Changes in your vision or hearing?

P: No.

D: Um, how about a stuffy or runny nose?

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

D: Okay um, and then change in your smell or taste?

P: No, that's been normal.

D: Okay, and how about chest pain?

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

D: Okay. Um, and do you ever feel like your heart's racing?

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

D: Okay, how about calf pain when you walk, like more than a block or two?

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

D: Okay, any changes to your bowel movements?

P: No things have been normal there.

D: Okay, any nausea or vomiting?

P: No. 

D: Uh, changes to your urine?

P: No. 

D: No. Uh, headaches?

P: Every once in a while, I'll get a headache, but it's, they're pretty mild. Usually I'll take an Advil and they go away.

D: Sure, um, how about dizziness or fainting spells?

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

D: Okay, um, any confusion or memory loss?

P: Uh, I guess I um, forget things a little more easily now, but, that's just part of getting older. 

D: Okay, sure. Um, and then other questions I have for you, are um, are you otherwise healthy? Do you have any major medical, medical conditions?

P: Uh, I have arthritis um, in my knees and uh, hands, um so I have a lot of pain from that sometimes, and I also have high blood pressure and um, GERD. 

D: Okay.

P: Or acid reflux, yeah.

D: Sure. Do you take any medications for these things?

P: Um, yeah, I'll take Tylenol um, for the arthritis, and sometimes use some like, topical creams for my knees. Um and uh I, I take amlodipine as well, I think, for the blood pressure. 

D: Okay. Okay, and um, are you up to date with all your immunizations?

P: Yeah, yeah, I remember getting one not too long ago, actually. Well, seven years ago I guess now, but I didn't realize, that we uh, had to get anymore. 

D: Um, so yeah, after you turn 65, they should've given you the Shingrix for shingles and pneumococcal vaccine, does that sound familiar?

P: Yeah it does. Yeah, I just didn't know about them until that time.

D: Okay yeah, sure. Any allergies that you have?

P: Uh, I don't think so.

D: No. How about family history of lung or heart conditions?

P: My uh, grandfather had, had lung cancer. And he was in his uh, 70s when he, when he passed away, I remember.

D: Okay, okay. And do you currently smoke?

P: I do, yes. Yeah, I, I smoke um, I don't know, maybe half a pack a day now, which is, it's a lot less than I used to. I was smoking two packs a day at one point.

D: Okay, well congratulations on cutting down. Um, yeah, if you need help cutting that down even more, let us know, we have resources that you may be able to use.

P: Yeah, absolutely. Thank you.

D: Yeah, no problem. Do you do any other recreational drugs like marijuana, cocaine, heroin, anything like that?

P: Yeah since I, oh CBD drops, I, at night I find that helps with uh, sleep and, and the pain in my knees.

D: Oh okay, are those prescribed drops?

P: Um. well I do buy, I get them from uh, like the uh, the OCS store, I think they're called.

D: Okay yeah. Okay, that's good that you're getting them from, like an official store.

P: Yeah they're for, they were, uh, my friend said that they worked for her, and so I just gave them a try and I, I found that they've helped.

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

P: Yeah, so I live in uh, in an apartment with my, with my husband.

D: Okay, And any like, old carpets, dust, mold, or asbestos in this apartment?

P: No, I don't believe so. It's relatively new. We just moved out of our house, uh, just to make it a little easier on us.

D: Okay yeah, for sure. Um, have you been in contact with anyone sick recently?

P: No, I don't think so. I've been spending a lot of time at at home uh, with my husband, and he's been okay.

D: Okay, good. How about travel?

P: No, we've been pretty scared with uh, COVID and all that, so we've been staying, staying home for the most part.

D: Okay, okay, good. Um, those were all the questions that I had for you today. Did you have any questions of your own for me?

P: No, I was just really concerned when I started to see um, the blood coming up more recently, and so I was just hoping to get this figured out.

D: Yeah, for sure. Um, so they're a couple of things we're gonna work you up for. Um, because some of your symptoms overlap with COVID, we'll start by getting a COVID swab and you should hear back in about 24 to 48 hours. Um, we will also do a chest x-ray um, to look for any signs of lung cancer. Um, and then if we see consolidation or anything that would indicate um, like a mass in your lungs, we will discuss options for like biopsies which is the gold standard for diagnosing lung cancers. Also, I know you haven't had any recent travel or anything like that and your symptoms have been going on for a long time, but uh, it may also be worthwhile to uh, also check for things like TB, which could also cause you to cough up blood. Um, so we'll start, we'll start from there, and then if those come back negative, then we'll work you up further for other things that you may have, but are like more rare. How does that sound?

P: That sounds like a good plan. Thank you. 

D: Okay, great. No problem.