D: What brings you in?

P: Uh, I've had this cough. It's been going on now for like last six months or so and been losing some weight as well. I've lost, I think like 20 or 30 pounds in the last six months.

D: OK, yeah, that's a lot of weight. So the weight loss, you said 20 to 30 pounds?

P: Yeah yeah. 

D: OK.

P: Like just over 200 and I'm in the 170s now.

D: OK, so that was in the past six months. When do the cough start?

P: Well, I've had a cough before, uh, like a smokers cough. Ah, and that's been like a few couple of years, but that's just a cough that I would have in the morning and it would just go away but I mean around six months ago I started having this cough all day.

D: Hm, OK. And is it a dry cough or is it a productive cough?

P: Uhm, it's been it's been dry. 

D: It's been dry?

P: Yeah.

D: So no blood or sputum?

P: Uh no, no blood or sputum. 

D: OK. And have you been feeling short of breath at all?

P: Uhm, I have, yeah the shortness of breath has been like similarly getting a bit worse over the last, over the last six months. 

D: OK. Alright, and is there wheeziness as well?

P: No wheezing. 

D: How about chest pain?

P: Uh, yeah, I've had this kind of like dull kind of aching pain that, that I've had kind of work just on the right side of my chest. It, yeah. It's kind of aching and not that bad, but uncomfortable. 

D: OK, and and is it a sharp pain or is it a dull, achy pain? 

P: It's more like dull. 

D: OK, and is it always there or is it worse with like exertion?

P: It's always there. 

D: OK. Uhm, and sorry, you said it was at the centre of your chest?

P: More kind of on the right side.

D: OK, does it get worse with like deep breaths?

P: Not really, no.

D: No, OK. How about when you lean forward?

P: No.

D: No, OK. Uhm, and hm. Have you ever been worked up for the chest pain in the past, like to rule out heart attacks, blocked arteries, anything like that?

P: Uh, yeah actually, I had a stress test about a year ago and it the results of that were, were normal.

D: OK, OK good. And do you ever feel like your heart's racing?

P: No, I haven't had any anything like that. I mean like, sometimes I can get palpitations 'cause I have a fib or atrial fibrillation, but it doesn't really yeah, affect me that, that much.

D: OK. And how about shortness, sorry, how about dizziness or fainting spells?

P: Nothing like that.

D: No. Any calf pain when you walk a lot?

P: No.

D: No, OK. Any fevers?

P: No.

D: No. How about fatigue?

P: Not really, no.

D: No, any rashes?

P: No.

D: Changes in your vision or hearing?

P: No.

D: Smell or taste?

P: That's been normal.

D: OK. Runny nose or stuffy nose?

P: No.

D: Sore throat?

P: No.

D: Uhm, changes in your bowel movement?

P: No diarrhea.

D: And how about like blood in your stool or constipation?

P: No constipation and no blood in the stool.

D: OK, nausea or vomiting?

P: No. 

D: Uhm, appetite changes?

P: No way my appetite's been been OK, that's why I was like really shocked at the the weight loss.

D: Mhmm. Umm OK, how about changes in your urine?

P: No, I mean sometimes I can have a, I mean harder time to go 'cause as an old guy have large prostate I think they said, but I mean that's been OK.

D: OK. How about headaches?

P: No headaches.

D: Numbness or tingling?

P: No numbness or tingling.

D: Confusion or memory loss?

P: No. 

D: OK. Joint pains or muscle aches?

P: I mean sometimes I can get so like my knees will hurt, but I think that's just arthritis. 

D: OK, yeah. Umm, alright and are you otherwise healthy? You mentioned that you have a-fib and prostate issues. Anything else?

P: Uh, yeah like high blood pressure and uh, yeah, uh just high blood pressure.

D: High blood pressure, OK. Have you ever been diagnosed with something called COPD?

P: No, I I I was tested for that with the like the breathing test, I did blow into tube but yeah, they said that I didn't have it.

D: OK. OK. When were you worked up for that?

P: I was probably like I don't know 5 to 10 years ago now.

D: OK. Alright, and are you on any medications?

P: Yeah, I take one for high blood pressure and I think a beta blocker as well for that like the heart rate and uh, a-fib.

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

P: I am yeah. 

D: OK, any allergies?

P: Uh, no allergies. 

D: OK. Family history of lung or heart conditions?

P: Uhm, I think like my uncle had lung cancer and it, and I think I've had a couple of member family members about who had lung cancer actually, but they've well, they've all been smokers.

D: Oh I see. OK. Do you know what type of lung cancer they got?

P: No, I'm I'm not sure.

D: OK. No problem. And OK, so I think you mentioned that you smoke. How much do you smoke and for how long have you been smoking?

P: I smoke about a pack per day and I guess probably even smoking now for, I mean, I, I guess like 60 years almost, maybe longer. 

D: OK.

P: And before that I there was a point I was smoking 2 packs a day.

D: Oh wow, OK, well it's good that you cut down. 

P: Mhmm.

D: Yeah, alright, and do you do any other recreational drugs?

P: No.

D: No, OK. And how about alcohol? Do you drink?

P: Probably one or two beers every day.

D: Every day, OK. And what's your living situation like right now?

P: Yeah, so I live with my wife in a in a townhouse.

D: OK, OK. Alright, that's good. Any reasons to think you have like old carpets, dust, asbestos, mold. Anything like that in the house?

P: No, I don't think so.

D: Uh, OK.

P: Yeah. 

D: Alright, any pets?

P: No pets.

D: No pets, OK. Have you been in contact with anyone sick recently?

P: No, I don't think so.

D: No, OK. How about travel?

P: I've been, uh, yeah we've been at been at home.

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

P: Uhm, no, I was just like, well, really worried that I I could have lung cancer. 

D: Yeah, for sure. So that is quite high on my differential right now just because of your age, your smoking history and just the way you're presenting. So we're gonna do a couple of things. We're going to do a Covid swab just to rule that out. You should hear back in about 24 to 48 hours, but we will do investigations for lung cancer, so we'll start by doing a chest x-ray just to look for a mass or effusions and then from there if we think there are signs of cancer, we can do a CT. Umm, as well we can like stage with the Pet CT after we take a biopsy and send it off for pathology and that should give us more answers as to if you have cancer and if you do have cancer, what type of cancer so that we can talk about treatment plans and kind of what the prognosis is with those particular types of cancers? How does that sound?

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

D: OK yeah, no problem.