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dataset\resampled_file\RES0153.wav | D: Uh how may I help you today?
P: Hi, I've been um just having this just sore throat for the last uh let's say three or four days.
D: OK, and um are you having pain with swallowing?
P: Um yeah, a little bit I've noticed uh with swallowing especially solids as well.
D: OK, have you noticed any changes to your voice? Like having a hot potato voice or or feeling as though your um your throat is kind of closing off?
P: Um not closing off, but like I definitely do uh, maybe a little bit of hoarseness, but not not too much. Mainly it's just the pain that's concerning me.
D: OK, and have you had uh a cough?
P: Uh no, I haven't had a cough at all.
D: OK. Um and have you had any um, any neck swelling?
P: Um I I I have actually noticed like a little bit of neck swelling just right at the front on both um, yeah, just at the front.
D: OK, um is it is it on both sides of your neck or kind of in the middle?
P: Um I would say it's more uh on both sides.
D: OK.
P: And just kind of like at the front, front of my neck.
D: OK, and you've noticed that um within the last three four days as well?
P: Yeah.
D: OK. Um and have you had any uh fevers or chills?
P: Uhm, I have had a fever in the last day like I've been feeling warm. I didn't get a chance to take my temperature. Um and also uh just to correct myself I, it's more so the swelling is just on one side. I've noticed like this lumpiness on one side of my neck.
D: OK, thank you yeah. We'll certainly uh, I'll look at it during the in the physical exam. Right, so so yeah, you've had a fever for the last two days?
P: Yeah, I would say so.
D: OK. Um And have you had any headaches?
P: Um no, no headaches.
D: Alright, and have you had any um like eye redness or eye discharge?
P: No, nothing like that.
D: Have you had a runny nose?
P: No.
D: OK, and any um loss of uh smell or or loss of taste?
P: No, nothing like that.
D: OK. Um and have you had any any shortness of breath or difficulties breathing?
P: Uh no, no shortness of breath.
D: Have you had any wheeze?
P: No, no wheeze.
D: OK. Have you had any um any chest pain?
P: No chest pain.
D: Alright, any dizziness or feeling like you were gonna faint?
P: Nope.
D: OK, do you feel like you're breathing faster or your heart's beating faster?
P: Uh, no, I haven't really felt that no.
D: OK. Um and have you had any, uh, any belly pain?
P: No.
D: How about any nausea or vomiting?
P: Um not, no, I haven't felt that at all.
D: OK, have you have you had any diarrhea?
P: No.
D: Have you had any urinary problems?
P: No.
D: OK. Have you had any any um skin changes or rashes anywhere?
P: Uh, no, not that I've noticed.
D: Alright, have you had any muscle aches or body pains?
P: Nope.
D: OK. Have you had any um any symptoms like this before?
P: Uh, no, not that I can recall. Um maybe when I was like like 7 years old like I may have had like a sore throat.
D: OK, so quite a while ago, yeah, and have you been diagnosed with any medical conditions before?
P: No.
D: OK. Um and uh so do you take any medications or anything over the counter?
P: Um I've tried like Tylenol cold, but it didn't really work.
D: OK, and any allergies to medications or environment?
P: No.
D: Are your immunizations up to date?
P: Uh yeah, they're all up to date.
D: OK, excellent, and um have you had any hospitalizations or any surgeries?
P: Um no, I've been pretty healthy.
D: Alright, excellent, and have you traveled anywhere recently?
P: No, I I've mainly stayed at home, I I'm mainly doing virtual school.
D: OK, have you been around anybody who's been been sick?
P: Um my my sister she she just got back from college and she she was complaining of like a sore throat uh two weeks ago.
D: OK, I see. Um uh who are you living with currently and where are you living?
P: So I'm living with my parents and my sister at, in a in a house just outside of the city.
D: OK. Um and is your sister doing better now or um what happened with her?
P: Yeah, yeah, I'm not sure, I think she did go to the doctor, now she's doing better. She did get some medications but I don't know what they were.
D: OK, I see. Um and uh I know some people in your age group will sometimes experience with uh like smoking or anything like that. Do you um do you smoke cigarettes or any of your friends?
P: No, I haven't I haven't done that.
D: OK, this same type of questioning for uh cannabis and alcohol. Um have you experimented with any of those substances or any recreational drugs?
P: No, not at all.
D: OK, um and are you currently sexually active?
P: No.
D: OK. Um and how's school going?
P: Uh school is going well, like uh it was uh it was weird adjusting to all the online stuff, but now I feel like I kind of got the hang of it.
D: OK, excellent. Um and um any concerns for um like safety at home? Anything that we talk about is, uh, is confidential.
P: No, I have a pretty pretty loving family.
D: OK, well that's great. Um and I just wanted to finish here with your family history. Um does anybody in the family have heart or lung conditions?
P: Uh, no, they they're pretty healthy, my mom and dad.
D: OK, and any uh other conditions that run in the family?
P: Uh no, I don't think so.
D: OK. Um uh so that was everything I wanted to ask um on the history today. Did you have any other questions for me or anything that that I didn't ask about you wanted to mention?
P: Uh no, nothing that I wanted to ask, just uh was just wondering if I need any medications.
D: OK, yeah, so um it's possible, so based on your symptoms currently it does suggest that uh it it is a bacterial cause with uh, since you don't have a cough and you have um like it sounds like sounds like lymph node enlargement. Um we'll we'll look and see if there's exudates or or purulence on your um, that we can see in your in your throat as well as checking temperature and do a rapid strep test. Um see if um if that's the cause, and if so, um then yeah, there will be a course of antibiotics um will be required, but um we will uh wait for um the physical exam and then the uh the rapid test.
P: Alright, sounds good. |
dataset\resampled_file\RES0060.wav | D: What brings you in?
P: So I've had a fever that I measured this morning and I had a cough. I've had a cough these last several days. Yeah, today is Friday so it started Monday, so I guess like yeah the cough started four days ago.
D: OK, and the fever started four days ago as well?
P: Well, I've been feeling hot this week, but I checked my temperature this morning and it was the first time I checked it and it was 38.5.
D: OK, so that's definitely a fever, so we can take your temperature today as well. Umm, so have your symptoms been the same or getting worse, or be getting better over the past few days?
P: They are getting worse. I've been starting to feel really fatigued and, uh, tired as well and the cough has gotten worse too.
D: OK, have you ever felt like this before?
P: I mean, maybe a really long time ago when I was a kid or something like that. Maybe I had the flu, but nothing recently.
D: OK. And do you have a sore throat at all?
P: No sore throat. It does get a little scratchy with my cough but hasn't been sore.
D: OK, and do you have any issues swallowing food?
P: No, but I haven't been as hungry.
D: OK, you haven't been as hungry. Um, have you had any changes to your taste?
P: No, I feel like I've been tasting my food OK.
D: OK, how about smell?
P: I feel like I've been able to smell.
D: OK, do you have a runny nose or a blocked nose? Do you feel congested?
P: Maybe a little runny, but not too bad.
D: OK, how about your hearing or vision? Any changes there?
P: No, I haven't noticed anything.
D: OK, any pain or discharge from either your ears or eyes?
P: No, nothing like that.
D: OK, so let's go back to the cough. Um, are you producing any sputum?
P: No sputum.
D: OK, so it's a dry cough?
P: Yeah it is.
D: OK, any blood associated with the cough?
P: I haven't seen any blood.
D: OK, do you feel wheezy at all?
P: I haven't noticed any wheezing.
D: OK, how about shortness of breath?
P: Usually well, after some of my coughing fits, I can be a little bit shorter in breath, but otherwise they've been.
D: OK, any chest pain?
P: No, I haven't had any chest pain.
D: Do you ever feel like your heart's racing?
P: No, I don't.
D: OK, and any night sweats or chills?
P: I have felt a little chilly at night, but I haven't had any night sweats.
D: OK, and how about weight loss? Have you had any weight loss over the past few months?
P: No, it's been about the same. Maybe down a few pounds over this week as I just haven't been eating as much.
D: OK, yeah. Umm, does anything make the cough better or worse?
P: Umm, no, I can't think of anything.
D: OK, and how have your bowel movements been?
P: They've, I would say they've been normal.
D: OK, and any abdominal pain?
P: No pain, but I have been a little nauseous.
D: Nauseous, OK. Have you thrown up?
P: No, I haven't vomited, but I've certainly felt like it a few times.
D: OK, and any triggers for your nausea?
P: Oh I can't think of anything. It just sort of came on. And it really went away on its own pretty quickly, but uh I don't know, maybe it was when I had my headache.
D: OK, when when did your headache start?
P: Um, so it's been on and off these last several days so I've been kind of resting a bit more too.
D: OK yeah, you said past several days, have you ever had headaches before that?
P: Yeah, I've had, I think they're called tension headaches. I get those every so often and will take Advil or something like that for them, and they usually go away.
D: OK. Do these headaches feel like the same headaches?
P: Yeah, they they feel about the same, kind of like a pressure or vice grip on my head.
D: OK, so it's not like the worst headache you've ever experienced?
P: No, I think it's just been a part of how I haven't been feeling well these these last few days.
D: OK, yeah. Do you feel fatigued or tired at all?
P: Yeah, for sure. I haven't really had any changes, but just haven't been really getting my work done throughout the day because I have just been feeling so tired.
D: Yeah, umm, and do you feel any sort of body aches that go along with your fatigue?
P: Maybe a little.
D: OK. Umm, can you think of anything that may have caused your symptoms? You know, have you been in contact with anyone who's been sick recently?
P: I can't think of anybody I've been around who's been sick, but last weekend I went shopping in the mall so I went into quite a few stores.
D: OK, and you were wearing your mask? Everyone else was wearing their mask?
P: Yeah, everybody far as I could tell.
D: OK, have you traveled anywhere recently?
P: Uh, no, I've just been home.
D: OK, I just want to ask you a few more questions. Any memory loss or confusion?
P: No.
D: Any dizziness or fainting spells?
P: Nothing like that, no.
D: OK. Are you otherwise healthy?
P: Um, yeah I've well, I've been told I had high cholesterol so I've been taking Rosuvastatin for that the past few years.
D: OK, and is it helping with the cholesterol levels?
P: Yeah, the last time I was at the family doctor I was told they were at a good level. O
D: OK, good.
P: I'm sorry I'm pre-diabetic as well.
D: OK, when was the last time you had blood work done?
P:: I think, uh six months ago.
D: OK, and that's when you were told you were pre-diabetic?
P: Yeah, I think my A1C was like 6.2% so uh, on the cusp.
D: OK, yeah, that's understandable. Um, have you made any sort of lifestyle changes to get your blood glucose under control?
P: Well, I have been walking the dog more. he weather is getting better and trying to eat out less often. Yeah, I've been trying to lose weight, but it it's been yeah, relatively stable still.
D:OK, we can review some options with you later on in the visit if you would like.
P: Yeah, certainly we can talk about that later.
D: OK, sounds good. Have you had any surgeries or hospitalizations in the past?
P: Yeah I had an inguinal hernia repaired about five years ago.
D: And are you on any medications?
P: Just Rosuvastatin right now.
D: OK, and any over the counter medications or herbal supplements?
P: Just a multi vitamin.
D: OK, umm, do you have any allergies?
P: Penicillin. I break out in hives.
D: OK, and did you need to be treated with any sort of antibiotics recently?
P: No, no, I haven't had any antibiotics for a long time.
D: OK, and are you up to date with all your immunizations?
P: I am, yeah, I get the flu shot every year.
D: OK, good. An yeah, that's really good. Um, do you know if you have any family history of any lung conditions or heart conditions?
P: No, I don't think so.
D: OK, how about cancers in the family?
P: I think my grandfather had bladder cancer, but, uh, I'm not sure.
D: OK, and I forget if I asked you earlier, but have you had any changes to your urinary habits, any changes in your urine itself or voiding frequency?
P: No, I haven't had any changes there and I haven't noticed any like blood or color changes. No pain.
D: OK, great. And do you smoke?
P: Um, no I do not.
D: OK, how about marijuana?
P: Nope.
D: Any other recreational drug?
P: No, I just have a few beers on the weekend. Like probably I don't know two or three on Saturday and Sunday.
D: OK, and where do you live?
P: I live in a like duplex and rent the basement in a house nearby.
D: OK, do you live with anyone?
P: Yeah, I live with my girlfriend.
D: OK, and um, any concerns for you know old carpets or mold or asbestos in the duplex that you're living in?
P: Not in our unit so I mean, maybe upstairs, but if it's anything like our place, then no.
D: OK. I think those were all the questions that I had for you. Did you have any questions or concerns that you wanted to bring up before we end the interview?
P: Uh, no, well I guess I was just concerned about about COVID.
D: Yeah, you know that's the top on my list of differential diagnosis for you. So what we'll do is a COVID swab and that should come back in a day or so, but we do encourage isolation for 14 days and that includes from your girlfriend as well. So even if the COVID swab comes back negative, sometimes it can be false negative, so as long as you're having these symptoms, and these symptoms are common in COVID, we do ask that you isolate for 14 days if the swab comes back positive. We will also notify public health so that they can get in touch with you and do some contact tracing to see where you may have gotten COVID from, but other than that, if it's not COVID, it could likely be another upper respiratory viral illness because of this time of year. A lot of different viruses are going around like common viruses or the flu, you know, so it could be one of those. And then if you're still sick or your symptoms change, we can reassess to make sure it's not a bacterial infection or bacterial pneumonia, in which case we can prescribe antibiotics.
P: OK yeah, thank you for all that information. Sounds great.
D: OK, well take care then, alright.
P: Thank you. |
dataset\resampled_file\RES0095.wav | D: How can I help you?
P: I've had, uh, worsening, uhm, shortness of breath, uhm, for the past couple of days.
D: OK, and, this has just been getting worse over the last couple of days?
P: Yeah.
D: OK, how far are you able to walk before getting shorter breath?
P: A couple of stairs, two to three stairs.
D: OK, and how far were you able, to, to walk before that?
P: Hmm, I'd say about ten or eleven stairs.
D: OK, and have you had shortness of breath like this before?
P: Yeah, uhm, six months ago.
D: OK, could you tell me about what happened six months ago?
P: Yeah, yeah, I was feeling all, I was feeling, just like this was feeling awful. I went to the hospital. They started me on a water pill, kept me for a couple of days and then sent me back home. Uhm, they changed some of my meds, I think, increased the dose of something and yeah that's what happened.
D: OK, I see and have you been having, uhm, any swelling?
P: Yeah, Oh my goodness, it's so bad I couldn't wear my shoes this morning. It's gotten worse over the past, one month.
D: Have you, have you had any changes to your weight?
P: Yep, gained five pounds in the past two months.
D: And have you had any changes to your appetite or, or diet or exercise?
P: I can barely exercise. I feel so short of breath. My dad's the same.
D: OK, uhm, and have you had any, uh, instances where you've woke up in the middle of the night extremely short of breath?
P: Yeah, that happened last night, couldn't fall asleep.
D: Did it help, uh, sitting up?
P: Yeah, I just went and sat on my chair and slept on the chair.
D: OK, and do you, uh, typically have problems with shortness of breath if you lie flat?
P: I do, I have to, uh, started using two pillows.
D: Is this a nightly thing?
P: It's, it's fine with the two pillows now.
D: OK. Yeah, and have you been experiencing any cough?
P: No.
D: Alright, and, uhm, how about any, any chest pain?
P: No.
D: Have you been having any, uh, instances feeling as though your heart's racing or beating out of your chest?
P: No.
D: Alright, have you had any fainting or dizziness?
P: Uh, no.
D: Alright, have you had any wheezing?
P: No.
D: OK, have you had any infectious symptoms such as uh, eye redness, eye discharge, nasal discharge or, or sore throat?
P: Not recently, I had that about two months ago, but that got better.
D: OK, did you need antibiotics two months ago?
P: No, no, just lasted a couple days and got better on its own.
D: I see OK and, uhm, have you been having any abdominal pain?
P: No.
D: How about any changes to bowel habits such as diarrhea or Constipation?
P: Uhm, no.
D: Any urinary problems?
P: I do, I, I uhm, I leak urine sometimes, actually quite often.
D: OK, and do you use any medications?
P: No I, I, well I do, I use a lot of medications, uhm, but I don't remember their names. Uh, I have this blister pack and I just take everything in it. Uhm, I also I brought the list of prescriptions, I can give that to you.
D: For sure, yeah I could go through, go through that, uhm here, uhm so, but first, have you been diagnosed with any medical conditions in the past?
P: Yeah, I have uh, heart, heart failure and uh, had two heart attacks and have high cholesterol, high blood pressure and, uh, I'm also overweight.
D: OK, do you know what your BMI is currently?
P: What's that?
D: So this is a measure of body mass index and, uhm, can help give an indication about weight ranges, uhm, whether, uhm, being in a healthy weight range or, uhm, a weight range that's associated with, uhm, risk of certain diseases such as high blood pressure.
P: No, I, I, I don't know. I, I've never heard of that. I, I know my weight, I could tell you that.
D: Sure yeah.
P: I'm 250 pounds.
D: OK, and yeah we can check that, uh, with your height today.
P: My height is 5'2".
D: OK, thank you. And, uhm, so just looking at the medications here now, I see a variety for uhm, cardiovascular protection, so things like aspirin, beta blocker, ACE inhibitor, statin, uhm and, uhm, do you have any allergies to medications?
P: No.
D: Uhm, and have you had any, uh, so you mentioned surgeries to your, to your heart? Do you have a stent placed?
P: Yeah, I had to stent put in after the first heart attack about five years ago and then another one, uh, three years ago.
D: OK, and have you, have you been stable in regards to your, uh, like chest pain? Have you had any?
P: No, I haven't had chest pain. I have a, uhm, a heart doctor who, uhm, I went to see after the last hospitalization six months ago. Things were looking OK at the time. He ordered a bunch of tests. I Haven't done all of them yet.
D: OK, do you know, uh, by any chance, what the, uh, last ejection fraction was on your echocardiogram?
P: I don't know, I, I don't know all of that. I don't know, you have to ask my daughter, she knows much more about me.
D: Yeah, no problem, well, we could look into, uh, some of those old, uh, older tests that you've done. OK, and, uhm, so can you tell me a little bit about your living situation currently? You mentioned your, your daughter, are you living with your daughter?
P: Yeah, I live with my daughter. My husband passed away, uh, three years ago, and so I've just been staying with my daughter. It's just the two of us now.
D: I see, I'm sorry to hear that about your husband. Uhm, are you currently, uh, like functioning independently around the home, or does your daughter help with a lot of the tasks?
P: Oh, she, she, she has to help me out, uhm she has to help me out. I uhm, I sometimes need help with the showering, simply because I get really short of breath and then, so I have to stop and it's just, she's just worried that it's unsafe, so she helps me out with that. Uhm, she gets most of the things done at home. She does the groceries and everything.
D: OK, I see, and do you, do you smoke cigarettes?
P: I, I don't.
D: And, do you drink alcohol?
P: Not anymore.
D: OK, do you smoke marijuana or use any cannabis products?
P: No, no, no, no, nothing like that.
D: Alright, then, uh, do you, uhm, use any other recreational drugs?
P: No, no I don't.
D: Alright, uhm, have you been around anybody who you think might have been sick?
P: No, I've just been staying at home. My daughter's been working from home too.
D: OK, so uh, you haven't had much contact with, uhm.
P: No.
D: With others recently? OK, have you, so you haven't traveled anywhere?
P: No.
D: Alright, uh, and uh, and in terms of family history, has anybody had any heart or lung conditions?
P: Oh yeah, everyone in my family has high blood pressure. My mom had a heart attack. My brother had a heart attack. My sister had a heart attack. Everyone, everyone has heart problems.
D: OK, certainly sounds like something, uh, common in the family. Has there been any other, uh, conditions that run in the family?
P: No.
D: Alright, uhm, I, I don't, I don't think I asked. Have you had any fevers or chills?
P: No.
D: OK and or, or any night sweats?
P: No
D: OK, and, uh, I might have asked, but just to, to be complete, did you have any nausea or vomiting?
P: No.
D: OK, uhm, so were there any other symptoms or anything else that, that I may have forgot to ask about?
P: No, I don't think so. It's just the, the difficulties with breathing and the swelling.
D: Yeah, so the first thing, I'll speak to your daughter and we will, uhm, get a look at some of the old or some of the reports from, uhm, over the last several months from, and from the cardiologist you see. But it's, uh, and then, uh, also we'll get some blood work and a chest x-ray. But it is sounding like this could be a heart failure exacerbation. Which, so some of the shortness of breath, it could be coming from fluid, uhm, that has accumulated in your lungs and so, uh, we'll give you, oh, another type of water pill now, Furosemide, to try and help get rid of some of that fluid so it will help with the breathing. And in the meantime, we'll wait for the investigations to come back.
P: Sure, Thank you. |
dataset\resampled_file\RES0113.wav | D: What can I do for you today?
P: Um yeah, so I'm here because I've had this fever, this cough, and now my head hurts. That's been going on for about the past four days and I just want to make sure um it's nothing too serious.
D: Yeah, yeah, that's great. So can you tell me, have you, did you measure your temperature?
P: Uh no, I haven't actually measured it, I just feel hot and feel chills.
D: OK, but we can take your vitals here um and uh you you said that you've had a cough for the past four days, dry cough or wet cough?
P: Um it's been pretty dry.
D: Um, any uh no blood or any um sputum um coming up right?
P: No, no.
D: OK and has the the cough gotten worse or better or the same, has it been the same since the past four days?
P: Um it's it's actually getting worse.
D: OK, is there anything that makes it better or worse?
P: Uh no, I don't think so.
D: OK. Uh have you tried anything for your cough?
P: I've tried like decongest like cough suppressants but it doesn't seem to have helped.
D: OK. OK, and then tell me about your headache. That started four days ago as well?
P: Yeah.
D: And uh where exactly is it?
P: So it's like just on the front part of my head.
D: And does it feel like uh, what does it feel like? Is it like a throbbing sensation? A band like sensation? Um is it sharp, is it dull?
P: Uh it feels pretty throbbing right now.
D: Is it both sides or on the uh left or right?
P: Uh it's it seems like it's both sides.
D: If you had to give it a number from 1 to 10 with 10 being the most severe pain ever, what number would you give it?
P: Uh I would give it about like a seven.
D: Oh wow, OK. And how's it changed over the past four days?
P: Uh, it's just gotten a little bit worse.
D: Um is it uh is it, what was I gonna say, is it constant or does it come and go?
P: Um It seems pretty it seems pretty constant.
D: Have you taken anything for it?
P: I tried like some Tylenol for it and it seems to help a little bit.
D: Does it, is there a certain time of the day when it's worse? Before going to bed, at the end of the day, waking up, anything like that?
P: No, nothing like that.
D: Have you had a similar headache in the past?
P: Uh yeah, I guess I have, a little bit in the past, but that was also when I was like sick.
D: Sure, um does it wake you up in the middle of the night?
P: Uh no, it hasn't woken me up.
D: OK, um I guess other than the headache, I'll ask you about, and the cough and fever, I'll ask you if you've had any other symptoms. So have you had any confusion?
P: Uh no, no confusion.
D: Any changes in your vision or your hearing?
P: No.
D: Um any um redness in your eyes?
P: No.
D: Any loss of taste or loss of smell?
P: No
D: Um any runny nose or stuffy nose?
P: Uh nope.
D: OK, any sore throat?
P: No.
D: OK. Any chest pain or difficulties breathing?
P: No.
D: Any palpitations? Do you feel like your heart's racing?
P: No.
D: OK, any belly pain?
P: No belly pain.
D: Diarrhea?
P: No.
D: OK, any aches or pains in your body?
P: No.
D: Uh any rashes that you've noticed?
P: No, no rashes.
D: Any discolouration of your fingers or toes?
P: Uh I don't think so.
D: OK, alright um and do you have any medical conditions?
P: No, I think I'm healthy otherwise.
D: OK, alright and have you had any hospitalizations or surgeries?
P: Uh, no.
D: OK, um what about medications? Are you taking any? Over the counter or otherwise?
P: Uh I take some multivitamins, that's it though.
D: OK, any family history of lung or heart problems uh or anything else, or cancers?
P: No.
D: And do you currently live alone or do you live with someone else or with other people?
P: I live with um my husband and our our daughter.
D: OK, have you had any, have you traveled anywhere?
P: No, not recently.
D: Have you uh, what do you mean by recently?
P: Uh like I have traveled in the past two years.
D: OK, that's fine, that's fine. Have you had any contact with anyone who might be sick? Either you or your husband or your daughter?
P: Uh no, I don't think so.
D: Have you gone out of the home at all?
P: Uh just to do like essential things like groceries and the bank and things like that.
D: Do you wear a mask and maintain social distancing?
P: Yes.
D: OK um alright, uh do you drink alcohol?
P: I drink like once once in a while, have a glass of wine.
D: OK, how, I guess how often would you say?
P: Uh once a week.
D: OK. And do you smoke?
P: Um no, not anymore.
D: Uh how much did you smoke in the past?
P: I I'd have like half a pack, um but I only smoked between like the age of 20 to like 25.
D: OK. Do you smoke marijuana or have any edibles with marijuana in it?
P: No.
D: Any recreational drugs?
P: No.
D: OK um alright well uh, and you said that you don't have a family history of any problem?
P: No.
D: Yeah OK, alright, I think that's all the questions I had for you. So uh looks like you've had a fever, cough, and a um and a headache that's gotten worse in the past four days and your headache's pretty bad, a seven out of ten. Um and uh it could be that you have uh some sort of an infection, uh including um, with Covid being one of the possibilities, and so um continue to take Tylenol and and um monitor your uh fever. If it continues to get worse, or you um notice that your symptoms are just not getting better, um you should come back, you should uh, we'll also do a Covid, we'll also send in a request for a Covid swab. Um and uh we'll ask you to quarantine for the for the next 14 days and try to stay away from your husband and daughter as well, if you can at home. Um and uh I guess a couple of other questions that I wanted to ask and I should have asked earlier, do you have any um any stiffness in your neck or any difficulties moving your neck?
P: Uh no, nothing like that.
D: OK alright, and um do you have any questions?
P: Uh No, that's it. Thank you so much.
D: Great. |
dataset\resampled_file\RES0117.wav | D: What brings you in?
P: Yeah, so I just came in today uh a bit concerned. Uh I've been just having this nasty cough for like the last week and then today morning uh, like I thought the cough would just go away, but today morning I also noticed I'm coughing up some blood.
D: Oh, OK.
P: Yeah.
D: So when did you first start coughing?
P: Um, so let me think uh I just returned from a mission trip uh to the Philippines 2 weeks ago. This cough started uh just last week, so I would say around six to seven days.
D: OK. And that and the blood in your cough, um that was about yesterday, you said? Or?
P: Yeah today, uh.
D: Today, OK. OK. Um are you bringing up any phlegm at all, besides the blood?
P: Uh no it's just uh like I saw it on my hand, like there wasn't anything, like my cough is like pretty dry.
D: OK, are you short of breath at all?
P: No, I'm not short of breath. Um just, it's just the cough.
D: OK, and are you having any wheeziness?
P: Uh no wheeziness.
D: OK. Um any runny nose or stuffy nose?
P: No, no uh runny or stuffy nose.
D: Changes in vision, hearing, smell, or taste?
P: Nope.
D: Uh weight loss?
P: Um I have noticed uh weight loss over the last uh, I would say few months. So I've been I've been doing like like I I came back from Philippines last week, but um, I had gone earlier, like during this year or two and I've kind of noticed this weight change, probably lost around 15 pounds within the last few months.
D: 15 pounds OK. Wow, that's a lot, yeah. Um any night sweats?
P: Um no, I don't think so, no.
D: Any fevers or chills?
P: I did have a, I did have some chills over the last week, um but I didn't really think too much of it.
D: OK, we'll take your temperature today just to make sure. Um any rashes?
P: No.
D: Any chest pain?
P: No chest pain.
D: Uh swelling in your limbs?
P: No.
D: Fainting spells or dizziness?
P: No, nothing like that.
D: Confusion or memory loss?
P: No.
D: Headaches?
P: No headaches.
D: Uh, joint pain?
P: No.
D: Fatigue?
P: Uh, no.
D: Um, changes in your bowel movements?
P: Uh, no. Not at all.
D: No, changes in your urine?
P: Nope.
D: Uh, nausea or vomiting?
P: No nausea or vomiting.
D: OK, how about abdominal pain?
P: No, nothing like that.
D: OK, are you otherwise healthy? Do you have any longstanding medical conditions?
P: Yeah no, I'm otherwise I um I don't, I'm really healthy. I don't take any medications so this was something that happened out of the blue.
D: OK, any um hospitalizations or surgeries in the past?
P: No.
D: No, um medications, are you on any?
P: No, I haven't um tried any medications.
D: OK. Um are you up to date with all your immunizations?
P: Uh I I've been yeah, pretty up to date with all my immunizations.
D: OK, uh, allergies, do you have any?
P: No.
D: Sorry, forgot to ask, immunizations. Did you get the flu shot this year?
P: Yeah I did.
D: OK, good. Any family history of lung conditions?
P: No, not at all.
D: No, any lung cancers?
P: No.
D: No, OK. Do you smoke?
P: No, I have never smoked a day in my life.
D: OK, recreational drugs?
P: No I would never take drugs.
D: OK. Do you drink alcohol?
P: No, no, not at all.
D: OK. Um where do you live right now?
P: So I I just live in a small apartment by myself, uh just been moving around a lot.
D: OK, for sure. Um any like asbestos, mold, or like old carpets, dust, anything like that at your apartment?
P: No, I don't think so.
D: No, any sick contacts recently?
P: Um not uh, I don't think so like we um, maybe in the Philippines, we do provide a, so I go on like these mission trips with the Church and um we do sometimes go to the hospital as well.
D: OK.
P: Sometimes yeah, we we do see some sick people.
D: Mhmm, OK.
P: But other than that, not since I've been here, no.
D: Any travel outside the Philippines recently?
P: Uhm, so I think. So this year has just been the Philippines, before I used to go to India as well. Um but recently nothing outside of the Philippines.
D: OK. OK, um those were all the questions that I had for you. Do you have any questions for me?
P: Yeah, I I was very worried um uh about the blood. I was just reading some things up and uh, about tuberculosis, so I was really stressed out today.
D: Yeah so um, that's definitely high on our differential. So, we'll do a couple of things. We'll do a Covid swab on you um just to rule that in or out, you should hear back for, about those results, in 24 to 48 hours. While you're here in the hospital, we're also going to do a chest X-Ray and or like an AFB smear to see if you have active TB or latent TB. If those come back positive um we will require you to isolate because this uh, because TB is highly infectious and it's airborne. Um so we have a couple of uh, we have like a regimen that we'd put you on. It's called the RIPE medications that we keep you on for two months and then we continue a couple of those for another four months. Um but we will uh keep you here until we have more answers on um like from this TB standpoint. How does that sound?
P: Yeah, that sounds good. Um yeah I'm really worried, but hopefully it's not TB.
D: Yeah, hopefully it's not, um but if it is, it's it's OK, like um we'll get infectious disease involved. Uh we'll get the isolation going and we'll get you on the correct treatment.
P: OK, thank you so much.
D: Yeah, no problem. |
dataset\resampled_file\RES0216.wav | D: So I understand you're having some chest tightness?
P: Yeah, it's uh, for the last maybe three days, um it's not really pain, not in any specific spot, it just feels a bit tight in my chest area when I breathe in especially, and it just gets a bit harder to breathe and it feels more tight like especially when I go for my walks, which I do everyday, uh I try to walk my dog. So I was just, you know, worried that it could be something serious and I wanted to come and get checked out.
D: OK, for sure. So you said it started about 3 days ago. Have you noticed it's been getting better, worse or about staying the same?
P: I think it's staying the same.
D: OK, was there anything that happened 3 days ago that you can recall where you first noticed it?
P: No, nothing in particular um yeah, it just kind of came on and now it's been pretty steady.
D: OK and when it came on three days ago, what were you doing?
P: Uh I think I first noticed it when I was gone for my walk.
D: OK, now when you're walking, you say you have some chest tightness, do you have any chest pain?
P: No, there's not there's not pain, it just feels like, when I breathe in it feels tight.
D: OK, did you feel anxious or sweaty or the feeling of impending doom at all?
P: Uh, no I can't say that I did.
D: Nothing like that, OK, and did you feel yourself becoming out of breath at all?
P: Uh I I feel like it was kind of harder to get a whole breath, um so yeah, yeah, I guess.
D: OK, and was this tightness all across your chest or was it in one particular area?
P: Kind of just all over.
D: OK. And since then, that happened when you were out for a walk, how many times does it happen a day would you say?
P: Well, I feel like it's kind of always there, but it gets worse when I go for my walk. Um and well sometimes I go for more than one walk, right, 'cause I walk my dog. It's always kind of there, and especially when I'm like getting up out of the chair, I can feel it more, or when I take a big like a big breath in, as I said.
D: OK, so it's been there pretty constantly for the past three days, but it's more noticeable, if not worse, when you're going for a walk?
P: Exactly.
D: OK. Have you had any cough at all in the last little while?
P: Uh no like I feel a little more hoarse and like there's maybe some more phlegm, like I'm clearing my throat more, but I haven't actually been coughing.
D: OK, any fevers?
P: No, can't say that, no.
D: OK, any night sweats, so waking up and the sheets are soaked?
P: No.
D: Any chills?
P: No.
D: Any unexplained weight loss at all?
P: Nope.
D: OK, and have you ever had anything like this happen to you before?
P: Uhm, I mean I have asthma um so I've had some trouble breathing before, it, this feels feels uh different than other times. I I guess it could be related, but uh I don't know, this this feels a bit different, that's why I wanted to come in and get it checked out.
D: OK, so you have asthma, do you use any puffers at the moment?
P: Yeah, I just use the one that um I take every day. I don't really use the uhm, the one thats as needed because I just haven't had to in a really long time so I didn't refill my last one.
D: OK, so you don't have any anymore of the as needed, but you have used it in the past?
P: Yeah, exactly like it's been a couple of years since I needed that, but I still I still take the daily one.
D: OK. And you haven't stopped taking the daily one in last three days either?
P: No, I always take it um so I'm supposed to actually take it morning and night, um for a while though sometimes I was skipping the night one because I didn't feel that I was needing it. Um so so lately I've been taking it everyday, but I've just been taking it in the morning.
D: OK, uh, what makes you say you haven't really needed the one at night? Have you just been doing well without it?
P: Exactly, like I haven't needed the rescue one in a few years and even when I was just taking it in the morning, I I haven't had any problems.
D: OK, understood. And then have you had, I should have asked, do you work currently?
P: Uh I I, I'm a financial advisor, I'm like semi retired so I do some stuff from home.
D: OK, got it. I suppose just, has this kind of chest tightness stopped you from doing activities that you normally would do, any missed time from work?
P: I haven't missed any work, but I'm not I'm not doing a ton of work right now. I don't think it would stop me, it just would make me uncomfortable um during work and it keeps me, maybe this, the last few days, it's kept me from, I usually go on a couple of walks a day, the last couple days I've just gone on one usually so yeah, it's a little bit, yeah.
D: So it's really not stopping too much of your day to day functioning, but it's noticeable?
P: Exactly, yeah.
D: OK. Now, is there any other issue that you see your doctor regularly for aside from the asthma?
P: Uhm, I have uh high blood pressure, I don't really see my doctor very much, I just am on um medication.
D: OK, how about we just talk about your medications a little bit? What are you taking currently?
P: Uh I take the, uh, salbutamol.
D: Yeah.
P: That we talked about, and I take um Ramipril.
D: Yep.
P: And, uh, sometimes a Tylenol if you know, if I have a headache or something, but not very often.
D: OK understood, so aside from the high blood pressure you're really not taking medications for much else?
P: No, no.
D: OK. Do you have any other lung issues or any trouble with your lungs in the past?
P: No, nothing major, just the asthma. But you know, like I said, it's been a few years since it has bothered me.
D: OK, got it, and just in terms of your life itself, so do you smoke at all?
P: No, never.
D: OK, so no smoking, any other recreational substances, drugs?
P: Oh no, no. I mean I I have um you know a few beers on the weekend, but I don't do very, I don't do any drugs and I don't drink much other than that.
D: OK, got it. Any allergies that you have?
P: Uhm no, no, like I, uh, when I was younger I got some seasonal allergies sometimes in the springtime, but other than that, I I like I, it's really been uh many years since I've noticed that.
D: OK, and so nothing new in the environment? You haven't changed where you've been living or you haven't introduced a new pet or a new dog?
P: Exactly.
D: OK, so sounds like you're pretty much staying the course last little while, just kind of a new onset of this new chest tightness, and aside from that, seems that it comes on mainly on walks outdoors, but you've kind of been limiting the, some of the medication you're taking for asthma the last couple of years because you haven't really felt that you needed it as much.
P: Yeah, like just the morning was, it was enough.
D: OK. Alright John, I think I've got most of the information I need just to go talk to the doc and talk about your story. Next of course we're going to do a quick physical exam, going to take a listen to your lungs and see what else we might want to do in terms of investigations. I have a feeling that this actually might be your asthma reoccurring in some capacity or that would be on the top of the differential for now, barring any other new findings. So I think maybe what we would like to do is, we'd like to try having those rescue puffers available to see if that helps at all when you are on walks, and if they don't help, then we'll come back to the table and see what other possible directions we could head in in order to help you next. Does that sound good John?
P: Sounds great, I'm just, you know, glad to know that it's probably not my heart.
D: No, it sounds well, I suppose you said that you didn't really get out of breath with exercise, more sounds like a chest tightness, and you haven't had any pain associated with it, so that puts more cardiac ischemic pictures kind of lower on the differential. But of course we're going to try one thing at a time, and then we'll come back to the table um depending on how you're feeling after that, OK?
P: Sounds great, thank you.
D: No problem. OK, I'll go talk to the doctor, I'll be back with you in a moment.
P: Thank you. |
dataset\resampled_file\RES0070.wav | D: What brought you in today?
P: Yeah absolutely. I have had this awful, awful headache for the past, two days I wanna say, its horrible.
D: OK, has the headache, uhm, stayed the same, gotten worse, gotten any better?
P: It's only gotten worse over the past two days.
D: OK, and when the headache started, was it like a thunder clap, kind of worst headache of your life when it came on?
P: No, no.
D: OK. Was there anything going on two days ago around the time of the headache, like did you hit your head or anything like that?
P: No, I just, uhm, I just went out for dinner, the night before and I know that there are certain foods that can trigger my migraines, but this really feels different. It doesn't feel like my migraine.
D: OK. Uhm, and have you had any other associated symptoms, with the headache.
P: I've been feeling really tired. I took the day off yesterday and today, I'm working from home, but I still decided not to get any work done today or yesterday.
D: OK. Uhm, and the fatigue, when did that start?
P: I think that started yesterday morning.
D: OK. And sorry, back to the headache. Have you tried anything for it?
P: I took Tylenol and Advil, but, I guess it did get better for about an hour a little bit, but it was back on again.
D: OK. And could you describe like where you feel the headache?
P: Sure, yeah, so it's like right in the front. Just kind of feels like a band, just like this pressure in the front of my head.
D: OK, and has there been anything that's made the headache worse, like lights or, or sounds?
P: No, no, like I said it's like nothing like my usual migraine headaches.
D: OK. And, I mean, the Advil or Tylenol, It helps the symptoms for a brief period, but has there been anything else that's helped your headache?
P: No, not really.
D: OK. And is there any particular time of the day that the headache's worse, like, is, in the morning time when you're first waking up or later in the day?
P: I don't think so.
D: OK. And have you had any nausea or vomiting?
P: No.
D: OK. And have you had any, like visual changes?
P: No.
D: OK. Uhm, and have you had a runny nose or a sore throat?
P: Uhm, I've had a bit of a sore throat.
D: OK, have you, have you had a cough?
P: Yeah, but honestly the headache's been bothering me the most.
D: OK, and when did the cough start?
P: About the same time.
D: OK.
P: Maybe two days ago.
D: OK, and have you had any neck stiffness? Does it hurt if you, if you move your neck around?
P: No, nothing like that.
D: OK, uh and with the, with the cough, have you had any difficulties breathing or shortness of breath?
P: Maybe a little bit.
D: OK, how about any wheezing?
P: No.
D: OK. Have you been bringing up any sputum with the cough?
P: No.
D: OK, how about, any, any blood?
P: No.
D: OK. And have you had any changes to your sense of smell?
P: No.
D: Any changes to your sense of taste?
P: No.
D: OK. Uh, and have you had any changes to your weight recently over the last several months?
P: I don't think so.
D: Alright, and how is your appetite been?
P: Uhm, it's fine.
D: Any chest pain?
P: No.
D: OK. Uhm any lightheadedness or, or feeling dizzy?
P: No, no.
D: Alright. Any nausea or vomiting?
P: No.
D: Any diarrhea?
P: No.
D: Any urinary problems?
P: No
D: How about , uh, have you had any muscle aches or joint pains?
P: A little bit.
D: OK. And any rashes anywhere?
P: No, no, no.
D: OK. And have you been diagnosed with any medical conditions before?
P: Uhm, I have, uh, I have migraines and uh, I also have Polymyalgia rheumatica.
D: OK. Are you taking any medications currently, for either of those?
P: No.
D: OK. And have you had any hospitalizations?
P: No.
D: OK, any surgeries?
P: No.
D: OK, and, uh, do you smoke cigarettes?
P: no.
D: Drink alcohol?
P: No.
D: OK and do you use any other, use any recreational drugs?
P: No.
D: OK. And any family history of similar symptoms like, like, unusual headaches or anything like that?
P: Well, migraines kinda run in the family.
D: Migraines, OK.
P: Yeah.
D: And any heart conditions or cancers or anything like that in the family?
P: No no no.
D: OK. And have you been around anybody who's been sick, recently? You went out for dinner a couple days ago.
P: Yeah, uhm, I don't think anyone was sick.
D: OK. And you didn't feel that you had any triggers to your migraines at that time?
P: No, I didn't. I did yes, I, I did meet up with my friends and we went out for dinner. I know we're not supposed to, but it's been such a long time.
D: Yeah.
P: I don't think they were sick at the time, but I haven't really talked to them after.
D: OK. Have you traveled anywhere?
P: No.
D: Alright. And so I don't think I asked, did you have a fever or chills?
P: No, not really.
D: Oh OK. Uhm, so the symptoms you've been experiencing, you've had a headache that's been the most bothersome these, these last couple of days, which feels different than your migraines but you've also had a sore throat, a cough, shortness of breath as well as a little bit of muscle aches and fatigue over these last couple of days.
P: Yeah that sounds right.
D: Is there anything else?
P: No, no, I don't think so.
D: OK, umm so, I'm going to get the attending and we'll go through a physical exam and get some investigations ordered so that we can try to figure out what's going on, ok.
P: OK, thank you.
D: You're welcome. |
dataset\resampled_file\RES0183.wav | D: How may I help you?
P: Hi there, I brought in my here because he's been barking, well not barking, he's had this cough that sounds like a barking cough and he's having a really hard time taking in a deep breath and money does it sounds, it sounds harsh.
D: OK, and when did the cough start?
P: It started about two days ago.
D: OK, is it a dry cough or wet cough?
P: It sounds pretty dry, yeah.
D: Alright, so so there's been no sputum and no no hemoptysis?
P: No.
D: OK. And it it does, the cough happen at any particular time of day?
P: Uhm, I mean no, well, actually mostly at night, but also it happens throughout the day. Umm, but yeah, more so at night.
D: OK. And, uh, has there been any shortness of breath or difficulty breathing?
P: Uh, no shortness of breath or difficulty breathing. It just sounds harsh when he does take a deep breath in.
D: OK. Uh, and any changes to, uh, to the voice or, uhm, yeah, like this is saying does he sound any different like a hot potato voice?
P: Uhm, no. It doesn't sound like that.
D: OK. And uh, uhm, that you mentioned umm, oh sorry, has he had any changes to the sound of his breathing?
P: The sound of his breathing. It sounds like it sounds harsh when he takes a deep breath in.
D: OK. So that sounds like he's having some stridor. Has he been having any wheezing?
P: You mean like when he exhales?
D: Uh, yeah.
P: Uh, it's more when he inhales that I hear it.
D: OK. OK. And has he had any eye redness or any eye discharge?
P: Uhm, no, I haven't noticed anything like that.
D: Is the other a runny nose?
P: No.
D: OK, has he had a sore throat?
P: No sore throat.
D: OK, and have you had a chance to look in his mouth, has he had any, like any redness or any swelling in the back of his mouth?
P: I took a look. It doesn't look swollen.
D: OK. And, uh, no shortness of breath I think you said?
P: Yeah, no shortness of breath.
D: OK. And has he had a sore throat?
P: No.
D: OK, and any changes to his sense of smell or sense of taste?
P: Uhm, not that I've noticed.
D: OK. And how has his appetite been?
P: Not as great as it usually is, but he's still eating.
D: OK. How is his like mood and behaviour been?
P: Uhm, he's been a little bit more fussy than usual.
D: OK. And eating less as well?
P: He's been eating less, but not like much less. I still try to get something in him.
D: OK, well, that's good. And has he had any chest pain?
P: Uhm, no, I don't think so. He hasn't complained of it or anything to make me think that he has any chest pain.
D: OK. And has he had any fainting, or mentioned that he's dizzy at all?
P: No.
D: OK, does he have any headaches?
P: I don't think so. He hasn't complained of that.
D: OK. Any ear pain or or ear discharge?
P. Uh, no.
D: OK. Does he have any abdominal pain?
P: No.
D: Does he have any diarrhea or constipation?
P: No.
D: OK, any blood in the stool?
P: No.
D: OK, and any skin rashes?
P: No, not that I've noticed.
D: OK, has he mentioned anything about muscle aches or joint pains?
P: Ah no, he hasn't.
D: OK. And is he had any nausea or vomiting?
P: No.
D: OK. And has he been diagnosed with any medical conditions in the past?
P: Uh, no, he's been a pretty healthy child.
D: OK. And sorry, just to go back and just summarize the symptoms overall, so he's had a "barky" cough that started two days ago, as well as some stridor or some noise on inhalation. And, and this reminds me, has he had any fevers or chills?
P: Uh, he has had a fever. Actually it was 38.7 yesterday.
D: OK, and any night sweats?
P: No, hasn't seemed sweaty at night, no.
D: OK. And has he had any weight loss in the last, several months?
P: Uh, no.
D: OK. And you said he hasn't been diagnosed with any medical conditions before, but so, has he had any reasons to be hospitalized or or any surgeries?
P: No, it's been a pretty healthy child.
D: OK, that's great, and any allergies that you're aware of?
P: Uh, I think he's allergic to penicillin.
D: Alright, what's the reaction?
P: Uh, he just gets a rash.
D: OK. And are his immunizations up to date?
P: Yes.
D: Alright, and currently who is he living with?
P: Ah, he lives with his, both his parents and his older sister.
D: OK, and has anybody in the family been sick, or is he been around anybody who's been sick?
P: No, everyone's been pretty healthy.
D: OK. Has there been any travel recently?
P: No, no ones traveled recently.
D: OK, and anybody smoke in the home?
P: Uh, no.
D: Alright, then any concerns for him being exposed to any forms of physical or emotional or verbal abuse or any violence in the home?
P: Oh no, no.
D: OK. And is he like going to daycare or who is the primary caregiver at home?
P: Uhm, it's usually his, his mom, yeah.
D: OK. And were there any complications throughout pregnancy, such as gestational diabetes or high blood pressure?
P: No.
D: Alright, and any complications with delivery and was it vaginal or C-section?
P: It was vaginal and no, no no complications.
D: Alright, and up to this point, as you better meeting is milestones for like talking, walking and and things like that?
P: Yeah, that's right.
D: OK, and uh, any concerns for his vision or hearing?
P: No.
D: OK, and has he been growing normally?
P: Yeah, he's had all his milestones.
D: Excellent, OK. And are there any conditions in the family such as heart or lung disease?
P: Oh, no.
D: OK. How about ah, asthma or things like allergic rhinitis and allergies?
P: No, nothing like that.
D: OK. Uhm, so I I think that was all the questions that I wanted to ask today on history. Was there anything else that I maybe forgot to ask about or or that you wanted to mention?
P: Uh, no, that was kind of it. What should I do for him?
D: Uhm, so it's it sounds like the most likely diagnosis now is something called Croup or laryngeal tracheal bronchitis, which is basically a viral infection of the upper respiratory tract areas, and so it can cause had a barky cough and stridor and fever. And so, if so, it's really supportive care and unless he decompensate's and becomes really short of breath and worse, in which case we could, the treatment would be steroids and uhm, possibly utilizing other other things as well, depending on his symptoms, but usually it will be steroids and maybe some oxygen as well. But if he stays relatively stable, then it's mostly supportive care, just making sure he's hydrated as much as possible, you could use like humidified air. Sometimes like a hot shower. That sort of thing can maybe help relieve the cough at night.
P: OK.
D: But umm, that's about it.
P: OK.
D: We'll, so, we'll so we'll just observe for now.
P: OK, that sounds good. Thank you. |
dataset\resampled_file\MSK0020.wav | D: What brings you in?
P: I've just come in today because I've been having some issues with my hips as well as my knees. Just over the last probably a month or two, I've been just getting, this stiffness and pain especially, uh, throughout the day as the day goes along, and I also experience some stiffness when I wake up in the morning, uh, in my hips and knees, so I just wanted to come and check out what that might be.
D: OK, and you said it started in the past month?
P: Yeah, maybe up to two months actually. Yeah, I would say two months.
D: OK, and is the pain and stiffness always there or does it come and go?
P: It's, it comes and goes. It's worse in the, so it's stiff, more stiff in the morning first, but like as the day goes on, probably near the afternoon it gets worse. So I've had to stop some of my activities like gardening and being outdoors and things like that.
D: OK. And you said it's, it gets worse with activity. Is there anything else that makes it better or worse?
P: Uhm, it probably, yeah, if I'm just exerting myself too much. Uh, in terms of better, I I think I've taken some Advil that does help with the pain.
D: OK, OK. And then if you were to describe the quality of this pain, would you say it's achy, throbbing, dull, or sharp?
P: It's kind of like this uh, achy pain, kind of deep within the joints themselves.
D: OK.
P: Yeah, it just gets worse. I, as I walk more and do more activities.
D: OK, and does the pain radiate also or does it, or is it pretty localized to your hips and knees?
P: It's mainly in those areas.
D: OK. And severity wise, one to 10, 10 being the worst pain you've ever felt, how bad is this pain?
P: Probably like a 7.
D: Seven, OK. And have you ever experienced this type of pain before?
P: Uh, no, not really.
D: And do you think your pain is getting worse?
P: Uhm, I think so. Like over the last two months, I feel like my pain, there's more stiffness, there's more pain throughout the day.
D: OK, OK. And yeah, so do you, are you experiencing any sort of numbness or tingling in the areas?
P: No, not really.
D: No, OK. Any muscle weakness?
P: Nope.
D: No. Are you still able to walk and do the things that you used to enjoy doing? I know you said gardening was hard for you. How about like other activities of like daily living like, uhm, cooking, using the washroom, things like that?
P: Yeah, those things I don't really have too much trouble with.
D: OK, OK, that's good at least. And any dizziness or fainting spells?
P: No.
D: No, OK. How about memory loss or confusion?
P: No, nothing like that.
D: Any headaches?
P: No.
D: No, OK. How about joint pains or muscle aches elsewhere?
P: Uhm, no, I haven't really felt any other pain in any other joint so far.
D: OK. And any weight loss recently?
P: No.
D: No, OK. How about and fevers or chills?
P: Uh, no fevers or chills.
D: No fevers or chills, OK. How about rashes?
P: No.
D: And changes in your vision, hearing, smell or taste?
P: Nope.
D: Uhm how about coughing, wheezing or shortness of breath?
P: Nope.
D: Uhm, chest pain, heart palpitations or fainting?
P: No.
D: Changes in your bowel movements?
P: Nope.
D: Uh, changes in your urinating?
P: Uh, no.
D: OK. And then are you otherwise healthy or do you have any past medical conditions?
P: Uhm, so I do have a prior history of hypertension as well as high cholesterol, diabetes, type 2 diabetes and also a bit more on the overweight side.
D: OK, uhm, are you taking any medications for all of this?
P: Yeah, so blood pressure, I'm taking this medication called Telmisartan. And then for blood pressure, I'm taking uh, metformin. Sorry, not blood pressure, for diabetes I'm taking metformin.
D: OK.
P: And then for the cholesterol I'm taking, and this medication, called Atorvastatin.
D: OK. Alright, and do you have any allergies?
P: No allergies.
D: No allergies. And how about immunizations? Are you up to date with them?
P: Yeah, as far as I know.
D: OK, that's good. How about family history of musculoskeletal issues?
P: Not that I know of, no.
D: No, OK. Then how about uhm, lung or heart conditions?
P: No. I I think my father, maybe he had some heart issues. He did have a heart attack in his, let's see, like in the 70s.
D: In his 70s, OK. OK, and then alright, and how about autoimmune conditions?
P: Uhm, I don't think so. Uh, I can't, I can't recall any autoimmune condition.
D: OK, an and do you smoke?
P: Yeah, I used to smoke a probably up until when I was like 65 or something. So, probably for 40 years of my life.
D: OK, how much did you used to smoke?
P: Probably a pack a day pack a day.
D: OK, uhm well, congrats for quitting. I'm sure that wasn't hard. I mean sorry, I'm sure that was hard. Uhm, yeah, so that's good. And have you, do you consume marijuana?
P: No.
D: Go to other recreational drugs?
P: No. No other recreational drugs.
D: OK, that's good. Do you drink alcohol?
P: Uh, nope, not anymore. I used to probably drink some wine here and there, but I've stopped drinking alcohol too.
D: OK. And who do you live with right now? And where do you live?
P: Right now, I live with my wife and we live in a small condominium.
D: OK. Uhm, alright, and then any recent sick contacts?
P: No.
D: No, OK, how about uhm, uh travel anywhere?
P: No.
D: No, OK, that's good. And now I'm just going to get you to do the physical exam part of this interview with me, is that OK?
P: Yeah.
D: OK, so we'll take a look at, if you can, if you have a mirror, we'll take a look at both hips first. Do you notice any redness or swelling on those hips?
P: No, not really.
D: No, OK. How about any atrophy, deformities, or skin changes?
P: No.
D: No, OK. And then how about on your knees? Do you see any redness or swelling there?
P: Not really, no.
D: No. Any atrophy, deformity, or skin changes there?
P: Uh, no.
D: No, OK. I'm gonna get you to palpate your hipbones. Does that hurt?
P: No, not really.
D: OK, how about when you do that to your knees?
P: Uh, the knee I can feel a little bit of I would say it's more of a discomfort then tenderness.
D: OK, so some discomfort on the patella palpation. Uhm, alright and then when you palpate those areas, do you feel like there is a grading sensation? How, does it feel warm?
P: No.
D: No, OK. And then I'm gonna get you to, can you flex your hips all the way so bend so from a sitting position stand up first? Does it hurt when you extend your hips like that?
P: Not right now. I think, I'm pretty sure my hips are pretty well rested right now, but there is still a little bit of stiffness.
D: OK. OK, so some stiffness on hip extension. How about when you bend your hips all the way?
P: Yeah, that's a I can't really go down that far. But yeah, even bending, as much as I can, there is some discomfort there.
D: OK, so some discomfort and some pain on hip flexion as well as limited range of motion.
P: Mhmm.
D: OK. Alright, and when you do both of those, do you hear any like what's called a crepitus or like a grating sensation where you feel like bone maybe hitting bone?
P: No, not really.
D: No, OK. Alright, and I'm going to get you to, uh, extend your knee, so straighten it out. Yeah, does that hurt?
P: Uhm, yeah, a little stiffness in my knees. I feel like I feel more of the grating sound in my knees.
D: OK, OK. And then how about when you bend your knees all the way backwards? You can do one at a time.
P: Uh, yeah I, yeah I definitely feel some discomfort there as well.
D: Yeah, OK. Alright, and how about when you point your toes to the ceiling?
P: No, that's fine. I can do that.
D: And then how about when you point your toes to the ground?
P: Yeah no issues.
D: OK, so no pain or limited range of motion with plantar flexion or dorsiflexion. OK, so those were all the test that I want to do with you today. Did you have any questions or concerns?
P: Uh, no, not really.
D: No, OK, uhm, so it sounds like what you may have is something called arthritis, which basically happens, uhm, when the cushions at the ends of your bones and your joints kind of degenerate over the years, and so bone can eventually rub on bone, which causes like the grading sensation and causes the pain. Uhm, and it's it happens in old age, it happens with wear and tear so to diagnose it, we we'll, yeah, we did the physical exam. We can also get an x-ray of your hips and knees which can have some findings that align with osteoarthritis and basically for now we'll try to manage it conservatively so you can take and sets like ibuprofen for the pain or acetaminophen for the pain. We'll also refer you to physiotherapy to strengthen those muscles around your joint and to increase flexibility and reduce that pain. Uhm, and another thing that may be worth considering is occupational therapy because they can help you find ways to do everyday tasks without putting too much stress on an already painful joint. And if these things don't work in the future, we can also discuss things like steroid injections or joint replacement. Does that sound like a good plan?
P:: Yeah, that sounds great, thank you so much.
D: OK yeah, no worries. |
dataset\resampled_file\MSK0041.wav | D: How may I help you?
P: I'm I am here because I've had this intense pain in my right foot for the past six hours or so or so, and I thought it was important to come get it checked out by you guys.
D: OK, so you say it started six hours ago has the pain been getting better or getting worse?
P: Uhm, it's been it's been the same since it started.
D: OK, and was there any trauma to the foot or anything happen within the last day, or in the last six hours?
P: No, not no trauma.
D: OK and, where is the pain located if you had to try to pinpoint it with one finger?
P: It's just below my big toe, kind of like on the medial side.
D: OK. Do you feel the pain radiating anywhere else, or you just feeling it at that one spot?
P: I'm feeling it just in that one spot.
D: OK. And how would you describe the pain?
P: It's intense, it's sharp.
D: OK, and and has there been anything that you've tried that's made the pain better?
P: Um no I haven't really tried anything. I've I can't seem to move it so every time I move it, it hurts. I'm trying to keep it pretty still and stationary. I took an ibuprofen, that's not, that doesn't seem to help.
D: OK. And so like any movement makes it it worse, is there anything else that makes it worse, like putting socks on or even having I don't know clothing touch it or your shoes touch it?
P: Yeah, I guess yeah, my shoes, my shoes touching it hurts.
D: OK, and are you able to walk?
P: I'm able to walk on it, it's just very painful and I can't you know, I can't bend that toe. I can't flex it or extend it, but my other toes are OK.
D: Alright, and how would you describe the severity of this pain. One being the least pain and 10 being the worst pain you've ever felt.
P: I say it's like an 8.
D: OK, and have you ever had a pain like this before and in your toes or or any of your other joints?
P: No, never.
D: OK. And have you had any neurological symptoms such as like numbness or tingling or sensory loss?
P: No.
D: OK, how about any muscle weakness?
P: No, nothing like that.
D: Alright, and have you had any any headaches?
P: No, no headaches.
D: Have you had any memory loss or or or confusion?
P: No.
D: OK. Have you had any fevers or chills?
P: No.
D: Have you had any unexpected weight loss?
P: No.
D: And have you had any any night sweats?
P: No.
D: OK, and how about any sensory changes like changes to your vision, hearing, sense of smell or sense of taste?
P: No changes there.
D: Alright and have you had a sore throat or runny nose?
P: No.
D: And how about having a cough or shortness of breath?
P: No, nothing like that.
D: OK, and have you had any chest pain?
P: No.
D: And how about any heart palpitations or feeling like your heart is racing.
P: No.
D: OK. And have you had any lightheadedness or dizziness?
P: No.
D: OK. And how about any nausea or vomiting?
P: No.
D: Alright, have any abdominal pain?
P: Nope.
D: Any changes to your bowel habits like diarrhea or constipation?
P: No, I don't think so.
D: OK, and have you had any changes to urinary patterns like pain frequency or incontinence?
P: No.
D: OK. And have you had any skin changes like rashes or any changes to your nails or hair?
P: No.
D: OK, and how about your energy, have you had a fatigue or malaise recently?
P: Uh no, nothing like that.
D: Alright, and any muscle aches or body pains or or any joint pains anywhere else?
P: No.
D: OK, um and have you been diagnosed with any medical conditions in the past?
P: Um no, I am. Actually sorry I have um high blood pressure as well as diabetes and I am a little overweight. But other than that, nothing else.
D: OK, do you take medications for any of those things?
P: Um I take ramipril for high blood pressure and I'm on insulin for the diabetes.
D: OK, have you had any medication changes recently?
P: Um no, no medication changes.
D: OK. And have you had any prior hospitalizations or surgeries?
P: I was recently hospitalised for kidney stones. But that since has resolved.
D: OK. Have you had any any surgeries?
P: No surgeries, just the lithotripsy for the kidney stone.
D: OK, and are your immunizations up to date?
P: Yep they are.
D: Excellent, um OK and do you smoke cigarettes?
P: No, I don't.
D: How about marijuana or using other cannabis products?
P: No.
D: OK and do you use any recreational drugs?
P: Uh no.
D: OK, and how about alcohol, how many drinks per week would you have usually?
P: Um alcohol have about. I usually have about 2 glasses of wine a day.
D: OK, and has that changed recently for you.
P: No, not really. I've just been I've also been start drinking like a beer every day as well recently.
D: OK. Alright, and alright could you tell me a little bit about your living situation right now who you're living with and and where?
P: I live with my son in a house.
D: OK, uh, and have you been around anybody who's been sick?
P: No.
D: Alright, and have you traveled anywhere recently?
P: Um no no travel recently.
D: OK, and and can you tell me a little bit about your diet an and like do you eat a lot of red meat and or a lot of seafood like like shell shellfish?
P: I eat a lot of red meats. But not a lot of um seafood.
D: OK. And. OK, and anybody in the family have a history of musculoskeletal or or neurological conditions?
P: Um so. Who OK, so my my father had like arthritis and I don't remember what kind of arthritis he had but he had severe arthritis. He also had high blood pressure and diabetes, and on my mother's side. Um there is some arthritis there as well and as well as gout and kidney stones.
D: OK. So that that was everything I wanted to ask all the history. And so, uh, next to ask you to have a look at your feet. And are you seeing any swelling, redness, or discolouration?
P: I see some redness and uh, some swelling in that area.
D: OK, and are you feeling any temperature changes?
P: Yes, and the right one is definitely warmer than the left.
D: OK, then how about any muscle atrophy in the foot or or lower leg or any joint malalignment or deformities?
P: Uh, so in terms of deformity is like it just looks swollen and so there's like a big bump on the right side of my foot, whereas it's completely straight on my left, but other than that, no deformities.
D: OK, and if you were to a palpate or press on areas of your foot or joints of your toes, are you feeling any any pains along the top of your foot or or in any of your other toes?
P: None of my other toes.
D: OK, and how about any pains at the ankle?
P: Um no pain at the ankle.
D: OK, so the metatarsals are not having any pain and then the joints of the 2nd 5th digits are pain free along with the ankle as well. Um and when it comes to range of motion, are you able to flex your toes downwards and extend them upwards towards your nose?
P: Yes, I can do that.
D: OK, and how about your ankle, are you able to um move your ankle on a full range of motion.
P: I can.
D: OK, and are you having a limping with, walking or otherwise called an antalgic gait?
P: Somewhat because I'm trying not to put too much weight on my right big toe.
D: OK. Alright, and so I think that was everything that I wanted to ask and check today. So did you have any other questions or anything that I maybe forgot to ask about you wanted to mention today?
P: Um no just what can I do for my foot how do I make the swelling go down?
D: Yeah, for sure it's so right now with having a like a red, warm and swollen joint that that's extremely tender and has limited range of motion. It's important to rule out a septic arthritis, however. Based on several of the risk factors such as diabetes, and obesity, as well as your family history of arthritis and gout. Taking the most likely thing is that this is a gout flare, and in particular in the toe like that it could be called podagra and so we will need to get a aspiration of the joint fluid just to send it off and make sure that it's not not an infection and that we're treating the right thing. If this is, gout and it comes back that this way it's treated with that high dose, high doses of anti inflammatories. I will start with medication called colchicine to help with this flare, and in the meantime, important things for preventing this in the future are diet and kind of lifestyle related with reducing things like red meats, alcohol, weight loss and um just trying to improve the diabetes management as well.
P: OK, that sounds great. Thank you.
D: Alright, thank you, we will get that started. |
dataset\resampled_file\RES0050.wav | D: I was wondering if you could tell me what brought you in.
P: Sure, um, I have been coughing a lot. I've been feeling short of breath and I just feel really wheezy, so I thought I should come check it out.
D: OK, when did the cough start?
P: I've always had a cough. Well, I guess I've had a cough for the past five years, but over the past three days it's gotten a lot worse.
D: OK, did anything happen 3 days ago that has brought the cough on?
P: Uhm, no, I was, I did groceries, I came home and then I started coughing a little bit more and I haven't been able to stop since.
D: OK, is there any particular time of day that the cough is worse, like morning, night?
P: Uhm, it seems to be worse in the morning.
D: OK, and are you bringing up any sputum?
P: I am. Umm, and it looks yellow and sometimes even green.
D: OK. With your cough prior to three days ago were you bringing up sputum with that?
P: I guess some, but it was clear.
D: OK, and are you bringing up more sputum now, the same or less?
P: Um, more sputum, and sputum just looks different.
D: OK, have you noticed any blood?
P: No blood.
D: OK, and you mentioned you've been you've had a wheeze, when you do you notice that?
P: Uhm, I also, I guess I notice that mostly last night, yeah.
D: OK, um and what types of activities have you had shortness of breath?
P: Uhm, I guess walking, doing day to day things has made me feel a little bit more short of breath than I used to feel.
D: OK. And have you been experiencing any other symptoms besides the cough, wheeze and shortness of breath?
P: Um, I feel a little bit more tired, but other than that, no.
D: OK. So a bit more tired. How has your sleep been?
P: My sleep has been, um, pretty normal. It's been, yeah, it's been the same. I guess it's the coughing that's making me tired.
D: OK, have you had any ear pain or eye pain?
P: Ear pain, or eye pain? No.
D: Any discharge from either, either your ears or eyes?
P: No.
D: OK. Have you had a runny nose?
P: No.
D: Or felt congested?
P: No.
D: OK, have you had a sore throat?
P: Uh, no.
D: Or any difficulty swallowing?
P: Uhm, no.
D: Changes to your sense of smell or taste?
P: No.
D: OK, have you had any changes in appetite?
P: Uh, no, I don't think so.
D: Alright, and have you had any weight loss over the last several months?
P: Weight loss, no.
D: OK. How about have you had any fevers or chills?
P: Fevers or chills ah, no. No, nothing like that.
D: Nights, how about night sweats?
P: No.
D: Have you had any chest pain?
P: Ah no, no chest. Well my chest feels, I guess sometimes I, it feels painful because I'm coughing so much, but nothing more than that.
D: OK, do you get chest pain when you exert yourself physically?
P: Uhm, no.
D: OK, so it's just after the coughing?
P: Yeah.
D: OK and how would you describe the character of the chest pain? Some people will say sharp, dull, achy.
P: Um, I would say dull.
D: OK, and have you had any like heart palpitations, feeling like your heart's racing?
P: No.
D: And how about any episodes where you felt like you were going to faint or, yeah, pass out?
P: No.
D: OK. Uhm and have you had any swelling in your feet, ankles, hands?
P: No, nothing like that.
D: OK. And then have you had any urinary problems?
P: Um, no.
D: Any bowel problems?
P: No.
D: OK, and then any joint pains or muscle aches?
P: No, nothing like that.
D: And how about any rashes anywhere?
P: No.
D: OK, and then, sorry, have you had any nausea or vomiting?
P: Uh, no.
D: OK. In terms of your past medical history, have you been diagnosed with any conditions before?
P: Uhm, I have high blood pressure and diabetes.
D: I see. Are you on any medications for those?
P: Um, for the blood pressure, the high blood pressure, I'm on a beta blocker and then for my diabetes I'm on metformin.
D: OK, uh, do you, are you taking any other medications?
P: Um, just some calcium and vitamin D.
D: Any surgeries in the past?
P: Nope.
D: Any allergies to medications?
P: No.
D: OK. Are your immunizations up to date?
P: I believe so, but I recently learned that I should get something called the pneumococcal vaccine. I haven't gotten that yet.
D: Yeah, you're you're right. So for um, in Canada or anybody or in Ontario, at least, anybody who's older than 65, it's recommended to get this vaccine to protect against certain types of bacterial infections type which can cause pneumonia. So it would be good something that you can set up with your family doctor.
P: OK.
D: Yeah, and so are you, so do you smoke cigarettes?
P: I used to.
D: OK, and how much do you smoke or how much did you use to smoke?
P: Um, I smoked a pack a day and I smoked for 45 years, but I stopped two years ago.
D: OK, that's great that you were able to stop. Do you drink alcohol?
P: Uhm, occasionally like once every two weeks.
D: OK, and any triggers that you can think of you were exposed to either at work or home like chemicals or things that you were exposed to that you had to breathe, that you breathe in?
P: No, nothing like that.
D: OK, have you traveled anywhere?
P: No.
D: Alright, and have you been near anybody who's been sick or has similar symptoms?
P: Uhm, no.
D: Alright, and anybody in the family have a heart or lung condition?
P: Um, no.
D: Any cancers in the family?
P: Um, there was a liver cancer.
D: OK, and, I think that.. OK, and that was all I wanted to ask on history. Was there anything else that you wanted to tell me today?
P: Um, no, just um, what do you think the problem is? I've never felt this bad with my shortness of breath before.
D: Yeah, certainly so umm, it, it sounds like it could be maybe a viral infection that I brought on this cough and worsen the sputum. This could be a bacterial infection, it could be a COPD exacerbation and also one of the other things that we would have to consider right now is Covid as well and so we will do a PCR nasal swab for Covid and a chest Xx-ray and some other investigations as well and uhm, we will try to get to the bottom of what's causing your your shortness of breath.
P: OK, that sounds good, thank you. |
dataset\resampled_file\RES0149.wav | D: How may I help you?
P: Hi I um I just developed uh or I guess I just started having difficulties with uh breathing starting this morning. It was just very odd, I was fine yesterday night and then just this morning, I've had a really hard time breathing um and yeah, I thought I should come in and get it checked out. I don't know what's going on.
D: Yeah, certainly, and so uh like did this shortness of breath wake you uh like did you wake up, um like just like uh to kind of sit up to catch your breath, um or when did the shortness of breath start?
P: Um it was kind of after I woke up and I was sort of, um just walking around that I I noticed that I was feeling short of breath just walking around, which was so weird. You know that that doesn't really happen to me.
D: OK. Um and with this, with the shortness of breath, have you had had a cough?
P: No.
D: OK, and um have you had any wheeze?
P: Um no.
D: OK, and have you been having any uh any chest pain?
P: Yeah, I kind of, I guess it just hurts a little bit when I take a, when I breathe in.
D: OK is is this pain when you take a deep breath in?
P: Yeah, I guess so, yeah.
D: And where do you feel the pain?
P: Um it's kind of on my um right side.
D: OK, does the pain uh like radiate anywhere or do you feel it just in that one spot?
P: It's just uh it's just in that one spot. It's just this sudden and like like this stabbing sensation um when I'm like taking a breath in. Uhm, actually now that I think about it, it's it's kind of there even when I'm like breathing normal, but it's not as bad. When I take a deep breath it's like really, really bad or when I um yeah, when I like cough or like I'm laughing or something, it just gets really bad.
D: And when did you first notice this pain?
P: Kind of um late this morning.
D: OK uh have you tried anything for a for the pain?
P: Uh I don't know, it's just I just try not to take deep breaths, I'm just trying to just take a normal breath and try not to talk too much. And yeah, just like not doing anything that worsens the pain.
D: OK, I see and um did you have any trauma to that to that area recently like a car accident or I don't know, getting hit in the ribs, or anything like that?
P: No, no I didn't.
D: OK. Um and have you had any episodes where um or actually rather like, do you have any issues with lying flat and having shortness of breath?
P: No.
D: OK, and um have you had any headaches?
P: Uhm, no.
D: Have you had any uh fevers or chills?
P: No. I don't think so.
D: OK, and have you had any night sweats?
P: No.
D: Have you had any changes to your weight recently? I mean, like over the last several months.
P: Uh no.
D: OK, and um have you had any nausea or vomiting?
P: No.
D: How about any changes to your sense of uh taste or your sense of smell?
P: No, those are OK.
D: Alright, and have you had uh a runny nose or a sore throat?
P: No.
D: Alright. Um and have you had any diarrhea?
P: No.
D: How about any urinary problems?
P: No.
D: And have you noticed any skin changes or rashes?
P: No.
D: OK. Um and how about any uh muscle aches or body pains?
P: Um yeah, I kind of have uh, it's just my left leg hurts a little bit. I'm not quite sure why. But yeah, nothing else.
D: OK, whereabouts, uh where does it hurt um on your left leg?
P: Um kind of in the calf area.
D: OK is it is it swollen or have you noticed any redness of the skin there?
P: Yeah it is. It is swollen actually, compared to my right leg. It's a little bit warm too.
D: OK, um have you had any uh like periods of time where you were bedridden over the last several days or or last several weeks?
P: No.
D: OK, any surgeries recently?
P: No.
D: Alright, and have you traveled anywhere over any long distances recently?
P: Oh yeah, yeah, I came back um two days ago. Um I went to um I went to India to visit my family, there was a death so had to to go. I came back yeah, two days ago.
D: OK, yeah, that's quite a long flight and I'm sorry to hear about um the loss of the family. Um OK, um oh and that reminds me, have you coughed up uh any blood at all?
P: Uh no.
D: OK. Um and um I just wanted to switch gears a little bit and ask about your past health. Have you been diagnosed with any medical conditions?
P: Uhm I I've had um anxiety. And uh yeah, that's that's about it. I had asthma as a child, but nothing since then.
D: I see, and do you uh take any medications for anxiety or have you?
P: Uh no, I'm just trying to um, just trying to reduce my stress and and trying other other ways to sort of handle my anxiety before I, I'm just trying to avoid builds actually.
D: I see, OK. So do you take any medications like either prescribed or over the counter?
P: Uh no.
D: Do you have any allergies to um to medications or or environmental?
P: No.
D: Alright, and um have you had any surgeries in the past or any hospitalizations?
P: Uh I had my appendix removed when I was uh 30 years old.
D: OK, um and any complications with that?
P: No.
D: Alright, and currently uh whereabouts are you living and uh who are you living with?
P: Um I'm just living with my sister. And uh yeah, we we live in an apartment together.
D: OK, and has she been sick or have you been any, around anybody who's been sick?
P: No.
D: OK, um and uh any potential exposures to uh TB, uh either in your on your travels or or anybody that you that you know of?
P: I don't think so, no.
D: OK. Um and do you smoke cigarettes?
P: No.
D: And do you drink alcohol?
P: No.
D: Uh how about the use of any uh recreational drugs?
P: No.
D: OK, um and in the family is there a history of any bleeding disorders or any uh clotting disorders?
P: Uhm no, I don't think so.
D: OK, um and any heart conditions, lung conditions?
P: Um just a heart attack. Uhm both my grandparents on my dad's side uh had a heart attack and uh diabetes as well. Um I think both my parents have diabetes.
D: OK. Have you been tested for uh diabetes as well?
P: Uh yeah, yeah yeah I go to see my family doctor and my uh, he said my sugars were good.
D: OK, great. Um alright, so um you've been experiencing uh so this this chest pain when you breathe in deeply since this morning um as well as some more difficulty breathing, and some left pain uh left leg pain with with some swelling. Uh have you been, after travels as well, have you had any other symptoms?
P: No. I don't think so.
D: OK, so that was all I wanted to ask today on on history and before I went on to uh the physical exam, we want to check uh vital signs and have a listen to your heart and lungs and um measure the diameter of your of your shins as well. Um but um it'll be important to get uh some imaging of your of your lungs um to assess whether or not there's a pulmonary embolism um uh because that would be one of the more um life threatening, or potentially um complicating uh causes of what's going on right now.
P: Sure. |
dataset\resampled_file\RES0167.wav | D: What brings you in?
P: I've just had a real like a real bad cough. Umm, it's been going on for 4 or 5 days now umm, and I'm just, I'm having some trouble breathing. I'm coughing up like gunky green stuff. Uhm, yeah, it's just really bad. I haven't had anything like this before.
D: OK, so when did the cough start?
P: About four or five days ago.
D: Four or five days ago. OK, and, uhm OK. So for 5 days, did you do have any shortness of breath with that?
P: Yeah, it's uh, I'm just I feel like I can't, can't quite like breathe fully.
D: OK, uhm you can't quite breathe fully, so like when you take a deep breath in, you can't expand your lungs fully. Is that what you mean?
P: Yeah, yeah, I just overall I just feel like yeah, I'm I'm short of breath. I guess that's the best way to put it.
D: OK, so you're short of breath. And how about wheezing? Do you have any of that?
P: I don't think so.
D: OK. So when did this start again? You said if a couple days ago or a few weeks ago.
P: I think it was four days ago.
D: Four days ago, OK, and did you have like a runny nose or stuffy nose at that point?
P: Maybe a little bit. I wasn't really thinking about it too much.
D: OK, uhm sore throat?
P: No, not a sore throat.
D: Not a sore throat, OK. Uhm, how about changes in your taste or smell?
P: No, none of those.
D: OK. How about changes in your vision or hearing?
P: Uh, no.
D: Fever, weight loss?
P: I feel like I've I've probably had a fever the last couple nights. I've just been really hot in the evenings.
D: OK.
P: Yeah, I feel like I've had a fever. I don't know bout my weight. I don't weigh myself all the time.
D: Mhmm.
P: But nothing like major.
D: Any chest pain?
P: Feels a little like it hurts a little bit, like when I when I breathe in.
D: OK. Uhm, do you ever feel like your heart's racing?
P: No, I don't think so.
D: Alright, And any changes in your bowel movements?
P: No, no, that's all the same.
D: No bellyaches?
P: Nope.
D: No bellyaches?
P: Nope.
D: OK, how about changes to your urine?
P: Uh, no.
D: No, any dizziness or confusion?
P: No, uh no, not dizziness or confusion, but I have just been feeling very weak and tired.
D: When you say weak, have you like lost any of your like motor movements like your arms, legs?
P: No, no, not like that kind of weak. I just have felt like very rundown.
D: OK.
P: Just like just fatigued like more than usual, yeah.
D: OK. Are you otherwise healthy or do you have any longstanding medical conditions?
P: Uhm, I don't I don't have too much luckily, knock on wood. Uhm, I, I take a medication for my reflux.
D: Mhmm.
P: And I did, I did have a knee replacement, five years ago.
D: OK.
P: Other than that, like I don't, I haven't really been to the doctor for much.
D: OK. Uhm alright. Do you have something called COPD?
P: No.
D: No, OK. Uhm, are you on any medications?
P: Just that one for the reflux its uhm oh, it starts with an R. Uhm, Rabeprazole?
D: OK.
P: Yeah.
D: Alright and are you up to date with all your immunizations?
P: Uh, yeah.
D: Including like the pneumovax vaccine and the shingrix?
P: I had the shingrix the pneumo I think the doctor said we were going to look at that the next time I came in.
D: OK, sure.
P: So I I'm not sure I I know that I always say yes to these things, but I'm not sure because of Covid and stuff if I've been getting everything exactly on time.
D: Mhmm. OK, and how about uh, how about allergies? Do you have any allergies?
P: Oh, like uh, just seasonal. Not to any medications or anything.
D: OK. Uhm, have you been in touch with anyone sick recently around you?
P: No, like the only person I see is my husband. I guess him, and so he has a PSW that comes in to take care of him. He has a couple more problems than I do. So basically, we see I see him and her and we see we see our kids, but just like outside.
D: OK. OK and alright and then, uhm, have you traveled anywhere recently?
P: No, no
D: No, OK. Dietary wise, are you like eating healthy?
P: Yeah, yeah, I think so. I try to, you know, cook, you know, whole foods for us like lots of veggies and you know fish and good meat. Although in the past you know few days, I just 'cause I felt really rundown and fatigued, I haven't been eating as much as I normally do.
D: OK.
P: Otherwise, I think we pretty healthy I try to, you know, follow healthy recipes and find them online.
D: Yeah, for sure. Yeah, that's good. Do you, do you smoke?
P: No, no.
D: No, OK, and any other recreational drugs?
P: No, never.
D: OK. Do you drink alcohol?
P: I'll have the occasional glass of wine on a special occasion, but not frequently and not, not heavily.
D: OK. And where do you live and who do you live with right now?
P: Uh, just me and my husband. We live outside of town. We live in the country on a little farm.
D: OK. Any old carpets or dust or mold or asbestos in the, in the home?
P: No, no we renovated probably 15 years ago, and there's no no more carpet, and there were never any asbestos problems or anything.
D: OK. OK, well I think those are all the questions that I had. Did you have any questions for myself?
P: I don't think so. I just I hope you know we can get this figured out.
D: Yeah, for sure. So we'll start with doing a Covid swab because you have some symptoms that overlap with it, so you should hear back in about 24 to 48 hours with those results. But it does sound like what you're telling me with the wet cough and you know a little bit of shortness of breath, I think it's worthwhile to get a chest x-ray to see if you might possibly have a pneumonia, and if you do, if there is some consolidation we'll probably prescribe some antibiotics for that. Umm, how does that sound to you?
P: Sounds great to me. Yeah, I just you know, hope there's nothing serious going on.
D: Yeah, yeah, and it shouldn't be. It's probably 1 something that's been going around in the community and you haven't had any recent hospitalizations or surgery, so I wouldn't worry about like any of those atypical bugs just yet.
P: OK, OK, that's good to hear.
D: Yeah, for sure. Well, uhm, thank you.
P: OK, thank you. |
dataset\resampled_file\RES0172.wav | D: What brings you in today?
P: So two days ago I started to have this cough. Came out of nowhere. I haven't had a cough before and I, just today I've noticed the fever as well and and I've had a headache the last few days.
D: Can you tell me a little bit more about your cough? Has it gotten better or worse over the past two days?
P: So it, it's a it's been about.. well, it got worse at first and then it's been about the same since then.
D: Okay, and is it dry cough or wet cough?
P: It's dry.
D: Okay. Uhm? And does it ever wake you up at night?
P: No. Well, it kind of happens all throughout the day. Yeah, no, no, it hasn't woken me up at night.
D: OK, is there any, are there any triggers? Anything that makes your cough worse?
P: I can't think of anything really. It just kinda comes on like throughout the day on it spontaneously.
D: How do you take any medications to help with your symptoms?
P: Yeah, some over the counter cold medicines. I tried some to take Tylenol cold and sinus or something like that anyway and it did help me sleep a little bit with that the headache and just haven't been feeling very good, to help with that.
D: And tell me about your fever. Did you check it check it, check your temperature?
P: I did yeah today I checked it and it was, like just over 38 I think like 38.1 or two.
D: OK, what about your headache? Where exactly is it?
P: I kind of feel it all over. It's like a band night feels like it's just around my head and squeezing.
D: And, how like if you had to give it a number from one to 10? What number would you give it? With 10 being the worst headache ever?
P: I would say maybe a 5.
D: OK, and you mentioned that the Tylenol helped.
P: It did, yeah, probably took it down to a two or three. The headache didn't go away entirely. It was sort of still there, but did help.
D: Have you had any other symptoms? Have you had a confusion or is it any fuzziness? Or any flu like symptoms?
P: Uh, I have felt just tired and, over these last couple of days. That and I have had a sore throat as well.
D: Oh, you get OK. OK, what about a runny nose or stuffy nose?
P: Uh, no, nothing like that.
D: Any difficulties breathing?
P: No.
D: Any difficulty swallowing with a sore throat?
P: Ah is a little bit painful, but I've been able to to eat and drink okay, just really takes a little longer.
D: Any dizziness or fainting in the past couple of days?
P: No, nothing like that.
D: OK, any rashes or changes in their nails?
P: No, I haven't had anything like that.
D: Any changes in your? I guess have had any chest pain?
P: No, haven't had any chest pain, haven't had anything like that before.
D: Any belly pain?
P: No.
D: any changes in your bowel movement, any diarrhea?
P: No, no, I haven't had ah, any diarrhea.
D: OK, uhm any changes in your urination, any difficulties or any pain or any increase in frequency?
P: No, I've had a urinary track infections before so I know what that's like. I haven't had any of those symptoms.
D: OK, alright, good. And. Have you been diagnosed with any medical conditions in the past?
P: Uhm? No, I haven't. I had surgery on my knee when I was a teenager. I uh tore my ACL but it's been good since then.
D: Any hospitalizations?
P: No.
D: OK, any medications that you're taking, including over the counter meds?
P: Yeah, I just say I'm on birth control right now. I've been taking it for the last like five years.
D: OK, any allergies?
P: Oh no, I don't think so.
D: OK, good. And do you have any medical conditions that run in the family? Including any heart or lung conditions or cancers.
P: Yeah, my, my aunt had had breast cancer. But ah, and my dad has high blood pressure.
D: OK OK uhm. And do you currently smoke?
P: No, I don't.
D: Do you ever smoke in the past?
P: No, I I I I I've stayed away from that.
D: Good. Any marijuana or recreational drugs?
P: Yeah, sometimes, well, we'll smoke with like friends at a party I guess, but I haven't had any. I haven't done that in awhile.
D: Alright. Any alcohol?
P: Similar like sometimes at a party, but I mean yeah, it's been awhile for something like that, so I haven't really had any alcohol on in months.
D: And are you currently working, or?
P: I am yeah. So it's uh, yeah I work for this tech company so I've been able to do a lot of my stuff at at home.
D: OK, uhm. Have you had any exposures to anyone who could potentially be sick?
P: I will without, well, yeah I there a couple or last weekend. Actually there was a family party that we went to. It was outside, but uh, it, yeah, there's people around. There was nobody that was sick that I'm aware of.
D: OK. And and have you traveled anywhere outside the province?
P: No been besides that, the family party last weekend, but I mean that was just here in town so. It was close by.
D: OK, I guess I forgot to ask about a symptom. Have you felt that you've lost your sense of smell or sense of taste? Has it just been different?
P: Yeah, I said some actually now that you mention it right sense of smell has been different, which is kind of weird, 'cause I I don't have, everybody knows or I don't feel congested or anything. So yeah, but my taste has been OK.
D: Good. Well, that's all the questions I had for you. Given that your symptoms sort of sound like you may have a viral or bacterial infection and seeing that you were, you had some exposure to to other people even though they weren't sick, it could, it could be that they, they had some sort of an illness that they could transmit that they weren't just showing symptoms at the time. We will get a covid swab done just to make sure that that's not what's happening. It could be that. And I'll recommend that you continue to, you know, take Tylenol and rest and take care of yourself and if your symptoms worsen or stay the same for long period of time, definitely come back or call public health to get some guidance and try to stay away from others and self isolate for the next couple of days or at least clear covid swabs back or your symptoms improve. Or the next 14 days. So that's all I have for you today. Do you have any questions for me?
P: No, that sounds really good, thank you. |
dataset\resampled_file\MSK0016.wav | D: What brings you in?
P: I've um I've been having this numbness and tingling and I guess kind of burning sensation that well uh it's been happening more often in my uh left hand.
D: On your left hand, OK. And sorry when did you say this started?
P: Uh it's been going on for probably four or five months um.
D: OK.
P: Yeah, it first uh it would only bug me for a couple of minutes at a time and I could kind of shake my hand out, like flick like flick my wrist and um and it would go away after a few minutes. But now I'm starting to get uh like symptoms at night sometimes as well.
D: OK, so um it's gotten worse then, you said over the past few weeks?
P: Yeah it has.
D: OK um and is it always there? Is it persistent or does it come and go?
P: It comes and goes.
D: OK and what makes it better or worse?
P: Uh better uh I've tried some um Advil um and Tylenol and it's kind of the, hasn't done much um for the pain really, uh I think only the thing that kind of helps it is just not using it as much, um yeah.
D: Yeah, alright, um have you tried any like cold compresses, um topical creams? Anything like that?
P: No.
D: No, OK. And uhm if you were to describe the quality of how it feels like, does it does it, is it painful, is it tender, or is it just numb and tingling, kind of like when your foot goes to sleep?
P: Uh I guess I have, it is a bit painful as well, yeah. I have um like a burning kind of pain.
D: OK and 1 to 10, 10 being the worst pain ever, how bad is this pain?
P: Uh when it gets to its worst, I would say about a 6.
D: OK, OK. Um and have you ever experienced this before or is this kind of like the first time you're experiencing this?
P: Yeah, this is the first uh really like over these last three months, the first time I've been experiencing it, I think uh the first time that it started it started to wake me up at night though has been like about a couple of weeks ago.
D: Oh I see, OK. Um alright and do you feel like your symptoms are getting worse over the past few weeks or is it kind of the same?
P: Uh over these past couple of weeks, about the same. It's woken me up uh like two or three times at night.
D: OK, alright and do you have any numbness or tingling elsewhere on your body?
P: No, it's just um just kind of the the outside of my hand here, it's really only the first like 3 fingers.
D: OK, first three fingers so your um thumb, index finger and uh middle finger? Or your pinky to middle finger?
P: Yeah, it's just the uh my thumb index finger and ring finger.
D: And ring finger, OK.
P: And maybe just like a little bit of the um like of the ring finger too, but not all of it.
D: OK, um alright, so um any weakness in your arms or do you feel like you can still use your arms OK?
P: Uh yeah I haven't had any, uh, any muscle um weakness, I guess I may be a bit more clumsy um with uh with my left hand like I've dropped a few things, I've had it, a little bit more difficult time like opening jars or like car doors and stuff like that.
D: OK, OK, and any confusion or memory loss?
P: No.
D: Headaches?
P: No.
D: OK, um how about weight loss?
P: No, I haven't had any weight loss.
D: Uh fevers or chills?
P: No.
D: Uh rashes?
P: No rashes.
D: Changes in your vision, hearing, smell or taste?
P: No, that's been normal.
D: OK, how about um a cough?
P: Uh no, I haven't had a cough.
D: OK, um wheezing or shortness of breath?
P: Nope, neither of those.
D: OK. Chest pain or heart palpitations?
P: Um nope, I haven't had that.
D: OK, how about um changes in your bowel movements?
P: Uh nope, I haven't had any diarrhea and no no constipation and no blood either.
D: OK, good. Any nausea or vomiting?
P: No I haven't had any of that.
D: OK, any changes in your voiding?
P: Uh, no I I um haven't had any problems with urination.
D: OK, um are you otherwise healthy? Do you have any longstanding medical conditions?
P: Um I have hypothyroidism, so I take um like uh thyroxine for that and um I am overweight as well, or in obesity class one I think.
D: OK, and um do you take any medications for the hypothyroid?
P: Yeah I do, I take um I take uh Synthroid, I think.
D: OK, alright, and are you on any weight loss medications?
P: No, I've just been trying to uh change diet around when I can and um and trying to um exercise a bit more, but uh it's been it's been tough, especially now with my wrist or my hand bugging me.
D: Yeah, for sure. Um alright, and then are you up to date with your immunizations?
P: I am, yeah and I get the flu shot every year.
D: OK, that's good. Um and have you had any hospitalizations or surgeries in the past?
P: Um I, I, no, I haven't had anything like that.
D: No, OK. Um any allergies?
P: Uh no allergies.
D: OK, family history of lung or heart conditions?
P: Um my grandfather had a stroke when he was in his uh 70s, um and my dad has high cholesterol.
D: Have you been worked up for all of that? Like high blood pressure, diabetes, cholesterol?
P: Uh yeah, I think my family doctor checked a few years ago, but I've been healthy besides this um uh this this pain um so maybe that, yeah maybe that could be investigated as well.
D: OK, um any neural, neurological, or musculoskeletal issues in the family?
P: Um I think osteoarthritis, a few few people have that.
D: OK, um how about autoimmune conditions?
P: Uh no, I think I'm the only one with the thyroid.
D: OK, um how about cancers?
P: Uh no cancer.
D: No cancers, OK. Um alright and then, do you smoke?
P: I do, yeah, I smoke about um 5 to 10 cigarettes per day.
D: OK, and um for how long have you been doing that?
P: Uh probably yeah about the last 10 years, it was kind of around when I started working um in the warehouse here, um yeah.
D: OK, and have you ever thought about quitting?
P: I have, yeah I've tried, it's just such uh I mean people just go out and I mean have their coffee and cigarettes and it's sort of a social thing while at work, it it's kind of what people do so, I have been trying to cut down though.
D: OK, OK, that's good. If you need any resources, we have some that we can refer you to. Um and do you consume marijuana in any form?
P: Um no, I don't.
D: No, OK. Any recreational drugs.
P: Um nope, I don't use anything like that.
D: OK, how about alcohol? Do you drink?
P: Um I'll have wine every once in awhile on the weekends, maybe maybe a drink per week, something like that.
D: OK, um and have you been in contact with anyone sick recently?
P: Uh no, I don't believe so.
D: OK, how about travel?
P: No, I've been I've been at home and and just going to work.
D: OK. Um and and where do you live and who do you live with?
P: So I live with my husband and our two daughters and we live and we live in a house.
D: OK, um any concerns for STI's?
P: No, I'm just um, I've been monogamous with my partner now for uh over 10 years and um no concerns for uh an STI at this time.
D: OK, alright good, um so now we're just going to move on to the physical exam part um of this interview. Um so I'm going to get you to look at both your arms, hands, and wrists, um side by side. Does your left one seem at all more red, swollen, uh or hot.
P: No, no symptoms like that.
D: No, OK. And um do you, does that one seem to be more atrophied or are there any deformities or skin changes on that one?
P: Um maybe uh a little less muscle bulk on the, like where my thumb is.
D: OK, OK. Um and then I'm gonna get you to palpate certain areas of that arm. So let's start um at the top, when you when you press down on your shoulder blades or just at the very top of your um arm where your, or at the very top where your arm connects to your shoulder, does it hurt over there?
P: No, no pain there.
D: OK. So no pain on the acromion process or the scapula. Um any pain where your biceps are?
P: No.
D: No, OK. How about at your elbows?
P: Uh no pain at the elbows and full, I can move my elbows and shoulders, uh no problem either. And my neck doesn't hurt at all either, I can move my neck around.
D: How about when you um palpate your wrists, both sides, medial and lateral?
P: Uh, yeah no, no pain if I'm just pressing or palpating the wrist.
D: OK. Um and I'm going to get you to um straighten out your arm and flex at your shoulder and extend at your shoulder, does that hurt?
P: No.
D: How about when you flex your elbow and extend your elbow?
P: No.
D: Um how about when you flex your wrist and extend your wrist?
P: No.
D: OK, so I'm going to do a special test for something called carpal tunnel syndrome. Um so um I'm gonna get you to straighten out your left arm again um and right where um alright, how do we do this? OK, so with your right hand or with your yeah, with your right index finger and middle finger, you're going to tap um just below uh where the bulk of your thumb muscles are um connecting to your wrist. I'm just going to get you to tap that area. Do you feel tingling like an electric shock sensation in your hand or anything like that.
P: I do, yeah.
D: You do, OK, so that's a positive Tinel's sign. Um and then we're going to do one more test, so I'm going to, OK so make like a prayer motion with your hands like um putting your 2 palms together and then um and then instead invert your hand so that the outer parts are touching and your fingers are pointing towards the ground.
P: OK.
D: So kind of like upside down but with your outer parts of your hands touching. Um and then I'm going to get you to uh just hold your arms like that um for about 60 seconds. Do you feel any tingling, numbness, or pain in those fingers?
P: Yeah, I get a bit of uh numbness and tingling when when I do that.
D: OK, so that's a positive Phalen's sign test. Um alright, so that brings me to the end of um this interview, did you have any questions or concerns, anything that you wanted to bring up?
P: Uh just wondering about um what this could be.
D: Oh yeah, so um it seems like you have something called carpal tunnel syndrome. Um and that is, it's pretty common um so it can be caused by um a lot of things, but basically your median nerve runs through your forearm into your wrist, and anything that squeezes or irritates that median nerve can lead to carpal tunnel syndrome, um and some things include um like repetitive movements at work, um obesity, um any nerve damaging conditions like diabetes, um inflammatory conditions, but mostly just like workplace factors can can do it, um especially if you're working with like vibrating tools or on an assembly line that requires like repetitive and prolonged flexing of the wrist. Um so uh diagnosis, we just do that through like symptoms, physical exam, um we don't really need to do any imaging at this at this point. And to treat it um basically work modification, so taking frequent breaks, uh not doing those repetitive movements um as often um and then you can do things at home, like apply cold packs. Um and then we also have some like non-surgical treatments where we can uh splint, we can put like a wrist splint um while you sleep to relieve those nighttime symptoms. Uh you can take some NSAIDs to relieve pain, um and if those don't work, we can try corticosteroids, um and if that doesn't work, then we can also discuss surgery sometime down the line. Does that sound OK?
P: It does, yeah, thank you.
D: Yeah no problem. |
dataset\resampled_file\RES0058.wav | D: How are you?
P: I'm doing OK. Thank you. How are you?
D: I'm well thanks. What brings you in today?
P: So, usually we go to my favorite pizza spot for lunch and these last couple of days I've noticed I just can't taste it.
D: OK, when you say the past couple of days, do you mean two days, three days, four days?
P: I would say the last two days, yeah, just yesterday and today.
D: OK, so loss of taste, so you can't taste anything or you can only taste some things or you're just not getting the full depth of your taste?
P: Yeah, I really noticed it with the pizza, but with like other things too, it's just a yeah, really plain, it doesn't really have any flavor with the food that I'm eating.
D: OK, so it kind of tastes like cardboard.
P: Yeah, kind of, and I think, like, I mean part of that is that I maybe not smelling it as well either.
D: Yeah, OK. Umm, did you have any trauma to the area like the mouth area or the nose area in the past couple of days or days leading up to that?
P: Umm, no, not at all, no.
D: OK and do you have a fever at all?
P: Umm, I don't think so no.
D: OK, you have a cough?
P: Yeah, I've had a cough.
D: OK, a similar timeline?
P: Yeah, that's when the cough started, maybe three or four days ago.
D: OK. And is it a dry cough or a wet cough?
P: Yeah, it's a dry cough.
D: OK, so no sputum, no blood?
P: No sputum and and no blood.
D: And do you feel wheezy at all?
P: No wheeziness.
D: How about shortness of breath?
P: Umm, maybe after coughing, I've had a hard time catching my breath.
D: OK, sure, yeah. And how about any fatigue? Do you feel like you're more tired than usual?
P: Yeah, these past few days I have definitely. I felt more tired, I've been sleeping a lot more throughout the day and just I don't know, kind of lazy.
D: Yeah, and I know you mentioned you're having a hard time tasting. How about your appetite though? Do you feel like you've lost appetite?
P: I think appetite's been OK. I've been hungry.
D: Yeah, OK umm, how about muscle aches?
P: Umm, no, just tired.
D: OK and chest pain?
P: No chest pain.
D: Alright, do you have a feeling like your heart's racing?
P: No, nothing like that.
D: OK, any changes in your bowel movements?
P: Umm, yeah, well, I had diarrhea this morning actually.
D: OK, so some diarrhea this morning.
P: None before that though. It was just the one or kind of two times, but it hasn't happened since then.
D: OK, no constipation?
P: No.
D: No blood in your stool?
P: I know I didn't see anything red.
D: OK, how about your stool seeming like it's very dark? Almost to the point where it looks black?
P: Oh no, it it wasn't dark like that.
D: OK, good, any abdominal pain?
P: No.
D: Any issues swallowing food?
P: Umm, no issues swallowing food. My throat has felt a bit itchy. I mean I've been coughing alot.
D: Does it feel sore as well?
P: Not really or just kind of yeah, kind of scratchy.
D: OK, have you had a runny nose or a blocked nose?
P: Umm, not really.
D: No, OK, any rashes?
P: Umm, no. I haven't noticed any rashes.
D: OK, and are things normal with your urine?
P: Yeah they are.
D: How about dizziness or fainting spells?
P: Umm, a little bit dizzy I when I got out of bed this morning, but we sat back down for a couple of minutes. I felt better.
D: OK, good good. Do you think that this morning you were dizzy because you were dehydrated? Or is this like a normal thing for you?
P: I mean, I guess I could have been dehydrated. I didn't even think of that, but I mean, since the food didn't taste so great, I don't know. I probably didn't eat as much yesterday or the last couple of days. Maybe I haven't eaten as much.
D: OK, Yep. OK, do you feel weak?
P: I don't know, maybe. Maybe a little weak, but umm, just way more tired.
D: OK, any confusion or memory loss?
P: Umm, no, I have been able to do some of my school work.
D: OK, good. And you mentioned no rashes, right?
P: No rash.
D: OK, any weight loss over the past couple of months?
P:: Nothing like that. No weight change, it's been the same.
D: OK, how about umm night sweats or chills?
P: I felt a bit, umm, hot but not sweaty, just hot.
D: OK, so kind of like you have a fever?
P: Yeah, I guess so, maybe.
D: Sure any muscle aches?
P: Umm, no muscle aches.
D: Have you been around anyone who's been sick recently?
P: Yeah there is this guy in my class who was sick in class last week.
D: What kind of symptoms did he have?
P: Well, he had a cough and fever. Yeah, I think he had a cough and a fever and somebody said that. Maybe a sore throat or something like that.
D: OK, so yeah, some symptoms overlap with yours I guess. Have you traveled anywhere recently?
P: Oh no, I've been at home. We just started back at going in person to school again.
D: OK, that's good. And are you otherwise healthy?
P: Yeah, I haven't been diagnosed with any medical conditions in the past.
D: Oh good, OK. And do you have any allergies?
P: Possibly cats but we don't have any pets at home.
D: OK, good have you been around cats recently?
P: No.
D: OK and then any hospitalizations or surgeries in the past?
P: I did have my appendix taken out like 4 four years ago. Yeah, at the beginning of high school, but that was the only surgeryand everything went well.
D: OK, are you up to date with all your immunizations?
P: I am, yeah. I have my immunization card here actually.
D: OK, good. Any family history of lung conditions or heart conditions that you know of?
P: I know my grandfather had lung cancer, but he smoked his whole life also. Also diabetes but don't know if he had any heart problems though.
D: OK, I'm sorry I forgot to ask you, are you on any medications?
P: Umm, I'm not.
D: OK, and do you smoke?
P: Umm, I don't.
D: OK, how about marijuana?
P: Uh, no. Oh, but I guess I use a vape every once in a while..
D: With like marijuana?
P: No, it's like those flavored ones.
D: Oh OK, yeah. How often do you use that?
P: It's like a few times a day.
D: OK, and is there any tobacco in there or nicotine?
P: I think there might be, but umm, I don't know. I usually just buy the flavored ones.
D: OK, well, you should probably look into if it has tobacco or nicotine, because neither of those are good for your health. And so we can, you know, have a discussion later on trying to cut down or quitting completely if you are open to that.
P: Yeah, sure.
D: I'll just continue on asking you some other questions. Do you drink alcohol?
P: Umm, no.
D: And who do you live with?
P: I live with my mom, my step dad, and then my younger sister.
D: OK, do you guys live in a house?
P: We live in a townhouse.
D: OK, in the city you said?
P: Yeah, yeah, I live close. I go to high school not too far from here.
D: Oh, that's nice. And any concerns with the living arrangements in terms of you know, like it being an old building, old carpets, mold, anything like that?
P: No, I live in a nice place. It's usually like really clean.
D: OK, good, umm alright, so those are all the questions I had for you. Did you have any questions or any concerns that you wanted to bring up?
P: I guess the only thing that I was concerned about was possibly having COVID.
D: Yeah, you know, that's probably top on my list of things to investigate you for, so I would say COVID or other viral illnesses that could be going around this time of year. That would have less of a similar presentation, and so we will do a COVID swab for you. And in the meantime, if you could isolate for 14 days, regardless of whether the swab comes back positive or negative, and that would be great. If the swab comes back positive, we will notify public health and they'll try to trace where you could have caught this from and if it turns out it's not a viral illness, we will try to work you up for any bacterial infections which can be treated with antibiotics. So that's where we will start, does that sound good?
P: Yeah, that makes sense.
D: OK great, well have a great day.
P: Yeah, thank you. |
dataset\resampled_file\RES0164.wav | D: What brings you in here today?
P: Hey, I'm I'm the mom of, of the patient. He's he's a kid, he has had, he just had a cough and stuffy nose for the past three days.
D: OK, and so did they both start around the same time or one started before the other?
P: They started the same time. He's also had like these, these, his eyes have been like kind of red and watery as well.
D: OK, and is he, what kind of cough is he having a dry cough or wet cough?
P: It's a dry cough.
D: Dry cough, OK and and so with the congestion is he also having any kind of nasal drainage?
P: Yeah, it's it's like watery.
D: Watery OK so now are you noticing any kind of yellow or greenish material?
P: No.
D: OK, and he hasn't, is he coughing up any blood at all at any point?
P: No no no.
D: And so this started just recently three days ago. Was he in contact with anyone that's been sick recently?
P: I don't think so, but he has been like playing outside quite a bit. And sometimes he's just playing with the neighbours kids.
D: OK. Has this happened before?
P: Yeah it has, but I guess what I'm concerned about is the rash that he has now that he's never had before.
D: OK, and where is the rash, exactly?
P: It's on his face. It started this morning.
D: OK, and can you describe the rash for me like it's color, shapes, and what kind of looks like?
P: Small really small dots like kind of, uhm, like I'd say like brown in color. Like brownish dark reddish.
D: OK, let's just are they just located on his face?
P: Yeah, like it was on his face and it's kind of a little bit on his neck.
D: OK, uh and is he scratching at them at all?
P: Yeah.
D: OK, Um, OK and so they just started today. Have you had these rashes before at all?
P: No, no he hasn't.
D: OK, anything new at all that he has either eaten or any new clothing or new laundry detergent or soap, so anything at all?
P: No no.
D: OK. OK, And has he had any fevers or chills anything like that?
P: Uh, he has been feeling a little bit warm. I didn't really check his temperature.
D: And. And busy so, it started three days ago. Anything happened before 3 days at all that might have caused the symptoms?
P: I don't think so. As I said, he has been playing around with others so could have caught something?
D: OK, And OK, any kind of ah, have you tried anything that has helped him at all? Any medications?
P: Uhm? I haven't tried anything yet, no.
D: OK, and how often is he coughing? Is he coughing throughout the day or is it more so with exerting himself?
P: Um, it's just kind of all through the day. It's actually gotten a little bit better. Uhm, the cough has gotten better. But what I'm concerned about is the, the rash?
D: OK cough's gotten better yeah. Does he have visit rush it so is it mainly just on his forehead or also on his cheeks?
P: It's on his cheeks on his chin. It's kind of on his neck. It's kind of like this blotchy reddish, brownish like little dots. Kind of, it's not like, it's not raised, it's like flat.
D: OK, and uh. Is it kind of just a bit like a bright red rash that's kind of covering the cheeks or little little dots everywhere?
P: Kind of little dots.
D: OK, any anything on his nose?
P: Yeah, yeah, it's on his nose as well.
D: OK, um, OK, but no fevers, right?
P: He, I guess he might have had a fever. He was feeling warm.
D: OK. And any other symptoms like shortness of breath, sore throat, anything like that?
P: No, no, nothing like that.
D: OK. And otherwise, any other symptoms like just not like behavioural changes, not being himself, being more irritable at all?
P: So yeah, he's just been tired. He hasn't been doing anything, he's just been lying in bed. Hasn't eaten.
D: OK. Any at all, is he having any nausea or vomiting?
P: No.
D: Any diarrhea or constipation?
P: No.
D: Any changes in his urination?
P: No.
D: Any changes in his sleep or appetite?
P: No. Well, he has been eating little less, but nothing like nothing else.
D: OK. And has he been complaining at all of any abdominal pain or anything like that?
P: No.
D: OK. Otherwise that has he been healthy or if he had any medical conditions diagnosed?
P: He's been healthy.
D: OK. And and any previous surgeries or hospitalizations?
P: No.
D: Any medications that he takes regularly?
P: No.
D: And any family history of any lung or heart conditions?
P: No.
D: Concurrently, or like during your pregnancy with him, any complications at all?
P: No.
D: And did, was he meeting his milestones that developmentally in terms of, also with growth and height and everything like that?
P: Yeah, he seems to be doing OK come when he's doing as well as his other brother, his two brothers.
D: OK, and does he go to school at all? What grade is he in?
P: He's going to school. Um, online.
D: Online right now? OK, yeah. And any issues at school at all. Any complaints that we've been told?
P: No.
D: OK. Great, so, uh and how is the houses or your living situation like?
P: It's, uh, things are good, so it's him, his two older brothers, my husband and me.
D: OK, and has anyone been sick recently or had similar symptoms?
P: No.
D: OK. Alright. Has anyone in the family ever had any diagnosis of asthma, eczema, allergic rhinitis?
P: No.
D: No, nothing like that, OK. Alright, so yeah those are all the questions I had for you today. Do you have any questions or concerns?
P: No.
D: OK. So yeah, so, we'll, we'll be doing a couple we'll do a physical examination, I want to see examined with the rash looks like and there's many things that can cause a rash. There's uh viral infections that can cause some of the symptoms. The symptoms he's having mainly seen viral with a dry cough and runny nose. And then you can we have a rash as well. One thing I forgot to ask actually is is he fully immunized?
P: Um, he I guess he didn't get all his immunizations done earlier. He did get them a little bit later so we came from Syria as refugees. But I I'm thinking he got all his immunizations when he, uh, came to, when we moved to Canada.
D: OK, and is he complaining of joint or muscle aches at all?
P: No.
D: No, nothing like that, OK. Alright, so yeah, we'll do it like a full physical examination, and if it's more just a viral, it'll be something that we'll just have to monitor and do supportive care for. But if it's anything else we might need to do further investigations. OK, and we'll just do a COVID swab for him today as well as some of the symptoms overlap with COVID symptoms and you will get the results back in 24 hours to 48 hours and then further instruction from public health.
P: Sounds great.
D: Alright, well, take care, talk to you soon. |
dataset\resampled_file\MSK0019.wav | D: What brings you in?
P: I've just been having uh, this pain in my um right, right elbow, and it's just been getting worse over the last few days. I started having it around three days ago. Um, and it's just been getting worse with any kind of gripping motion or, yeah, so it's, it's been getting worse.
D: Okay, so you said it started three days ago. Um, has it been persistent since, or has it been like on and off?
P: It's been pretty persistent, um, but it's mainly when I'm uh, doing some activities or lifting anything. Um, and yes, I've just been trying to rest it mostly.
D: Okay, okay, that's good. And um, you said it's worse with activity and better with rest. Have you tried anything else for it?
P: Um, I've tried some Advil, it, it seemed to help a little bit, but uh, it just comes back.
D: Okay, um, and if you were to describe the quality of this pain, would you say it's sharp, burning, throbbing, achy?
P: It's more um, like if I don't extend my wrist, it's kind of like achy, but then if I extend my wrist, I feel like a sharp pain at um, on the um, just on the outside of my elbow.
D: Okay, alright. Um alright, and then um, in terms of severity, 1 to 10, 10 being the worst pain you've ever felt, how bad is the pain?
P: Um, probably like a 6 or 7.
D: Okay. Alright, um, and have you ever experienced this type of pain before?
P: No, I, I, I've never experienced any kind of pain there at least.
D: Okay. Um, how about um, in terms of like timeline, is it getting worse?
P: Um, just over the past three days, I feel like it's, I have tried not to use it that much. Uh, like when I was at work, I have to use like tools a lot um, and I noticed that when I was using a screwdriver, like it, it hurt a lot. So it hasn't been getting worse, but if I try to do anything at work, it definitely hurts a lot more.
D: Okay, um, alright. And then have you noticed any numbness or tingling?
P: Um, no, no, nothing like that.
D: No, okay. How about um, pain elsewhere on your body?
P: Sorry, what was that?
D: Pain elsewhere on your body?
P: Oh no, no pain elsewhere.
D: Okay, um, and have you noticed any muscle weakness?
P: Uh, no.
D: No. Any headaches?
P: No.
D: Dizziness?
P: No.
D: Uh, weight loss?
P: No.
D: Fevers or chills?
P: No.
D: Rashes?
P: No.
D: Uh, changes in your vision, hearing, smell, or taste?
P: No.
D: Uh, coughing, shortness of breath, or wheezing?
P: No.
D: Chest pain or heart palpitations?
P: No.
D: Uh, changes in your bowel movements?
P: No.
D: Nausea or vomiting?
P: No.
D: Changes in your voiding?
P: No.
D: Okay, and are you otherwise healthy? Do you have any longstanding medical conditions?
P: Yeah no, I've been healthy, uh, no other issues in my Life.
D: Okay, that's good. Um, how about, um, medications, are you on any?
P: No, no medications. I've just been taking some Advil for this pain.
D: Okay, I see. And how about immunizations? Are you up-to-date?
P: Yeah.
D: Do you have any allergies?
P: Uh, no.
D: Family history of any musculoskeletal issues?
P: No, just uh, I guess my dad, he's, he's getting some knee pain and hip pain now, starting now. But like that's about it.
D: How old is he?
P: My dad, he's 60.
D: Okay, and any lung or heart conditions?
P: No.
D: Autoimmmune condition?
P: Uh, not that I know of.
D: Okay, and how about cancers?
P: Um, I think my aunt on my mother's side, um, she, she had, uh, uterine cancer.
D: Okay, I see, alright. Um any allergies, or sorry, you answered that. Do you, do you smoke?
P: Uh, no.
D: No. Um, do you consume any marijuana?
P: Uh, no.
D: Do you drink alcohol?
P: Um, just, like maybe some wine on uh, wine, beer every couple days.
D: Okay, um, and where do you live right now? And who do you live with?
P: Um, I live with my wife and uh, four year old daughter.
D: Okay. Um, any concerns for STIs?
P: No.
D: Any sick contacts recently?
P: No.
D: Have you traveled anywhere recently?
P: No.
D: Okay, well um, let's move on to the physical exam part of this interview then. Um, so I'm going to get you to look at both your uh, arms and hands and you let me know if you see any redness or swelling in uh, your right arm compared to your left.
P: Okay. Um, so like, with movement?
D: Uh no, uh, just on inspection, do you see any redness or swelling?
P: Um, no, I don't really see anything that's too different, no.
D: No, okay. Uh, do you see any deformities, atrophy, or skin changes in your right compared to your left arm or hand?
P: No, they look pretty similar to me.
D: Okay. Alright, and then I'm gonna get you to press down on certain areas of your right arm. So you can start with the back of your elbow. Does that hurt?
P: Uh, just like right on the elbow, it doesn't hurt, but when I go on the outside part, it does hurt on the back.
D: Okay, so like the lateral aspect of your elbow?
P: Yeah, it's like sore if I press down.
D: Okay, how about the medial aspect of your elbow?
P: Um, so yeah, on the inside, not so much. Maybe a little bit, not, not that much.
D: Okay, how about when you press down on your biceps or triceps?
P: Uh, nothing.
D: Nothing. How about when you um, press down on your like, forearm extensor muscle group?
P: Um, just, yeah, so just on the outside of my forearm, close to where the elbow pain is, if I go down a little bit and press down, it does definitely feel sore.
D: Okay, and then how about with your forearm uh, flexor, flexors.
P: So on the inside, um, not so much, no.
D: No, okay. And now I'm gonna get you to walk through some movements with me. Um, can you uh, get a piece of paper and, actually can you get a pencil and grip it as tight as you can. Um, do you find that you feel weak when you do that?
P: Um, not weak, but it does definitely like um, when I picked up the pencil and moved my wrist up, it did, it did uh, cause some, some pain.
D: Okay, alright. So would you mind extending or like straightening out your elbow all the way and then also straightening out your wrists. Um, does that hurt?
P: Uh, straightening out, no, it doesn't hurt.
D: Even with uh, like the wrist um, straightened out?
P: Um, yeah if I, if I completely straighten out my wrist uh, then like I just feel a bit of uh, soreness, but not as much pain as when I, um, am lifting something with my wrist or just raising my wrist upwards.
D: Okay. Okay, how about when you flex your wrist all the way?
P: Um, that hurts a little bit, but not nearly as much as when I extend it.
D: Okay. Okay, um, those are all the questions I had for you today, and did you have any questions of your own for myself?
P: Uh, yeah, I was just wondering what this, this might be.
D: Yeah, so um, it sounds like you have something called tennis elbow or lateral epicondylitis. Um, and it's usually related to some overuse, um, injury, so whether at work, or if you play a lot of tennis or some sort of sport, that um, overuses a certain muscle group, um, particularly like the forearm extensors. Um, and so basically for this, um, we suggest a few things. We'll start with like some conservative management, like activity modification. So at work, if you're doing repetitive movements, maybe not do them so much and take frequent breaks, you can try some like ibuprofen, we'll refer you to some um, physiotherapy to help build those muscles around that, that area. And if those still do, don't work, um, we can try some um, other things like operative um, operative management, but we'll, we'll come back to that in about 6 to 12 months, um, once we uh, we try all of the other stuff. Does that sound okay?
P: Yeah, that sounds good. Thank you.
D: Yeah, no worries. |
dataset\resampled_file\RES0203.wav | D: Do you want to tell me what brought you in today?
P: Yeah, so for the past two days I I've I've noticed that I can't smell things as well, as I used to be able to smell them and I seem to have lost my sense of taste as well. And I have this mild dry cough. I'm just worried it's covid.
D: OK. You said for a couple days?
P: Yes, for two days.
D: OK, have you ever had anything like this before?
P: No, no, nothing like this.
D: OK, when you say you feel like you've lost sense of taste and smell, is it totally gone or do you taste a little bit? Or how? How is that working for you?
P: The smell isn't totally gone I can still smell something if it smells really really bad and and then and then I can taste really, really salty foods, but I can taste normal things like I can't taste of banana.
D: OK, is that been pretty consistent throughout the last couple of days or is it on and off?
P: It's been pretty consistent, yeah.
D: OK. And did this dry cough that start at the same time?
P: Yes.
D: And when you say sorry, you said mild cough, and I my next question was do you feel like it's a dry cough or you producing any sputum? Any blood? Or is it to not, not bringing up anything?
P: It's dry.
D: OK, has that gotten worse over the last couple of days?
P: The dry cough? Um it's been pretty consistent as well.
D: OK is there, have you done anything to try to make it better? Have you taken any over the counter medications or?
P: No, I haven't tried anything.
D: OK, OK. Have you had, in addition to these symptoms, have you had any fevers?
P: Fevers, no fevers.
D: OK, any difficulty breathing?
P: No.
D: OK, any headaches?
P: Um no, no headaches.
D: OK, any sore throat?
P: No.
D: OK, any chills or night sweats?
P: No.
D: OK, any muscle ache or general weakness?
P: Uh no.
D: OK, so generally it seems like you're pretty well other than this loss of taste slash smell and the dry cough that correct,
P: Yes.
D: OK and then recently have you been in contact with anyone that's been sick?
P: Um no not that I can remember or yeah, not that I can remember.
D: OK, have you traveled anywhere?
P: Um I went hiking with my partner two weeks ago. I guess there were some people who kind of brushed by us, but other than that I don't see where else I could have gotten this from.
D: OK, was that hiking somewhere close by?
P: Yeah, it was like half an hour from where we are.
D: OK. Are your immunizations up to date?
P: Yes.
D: OK, and can you think of any for this dry cough, just a circle back to that. Can you think of anything that triggers it? It's called the cold or being around certain things like cats or dogs or any other environmental things?
P: No.
D: OK. Have you had any chest pain? Thats the other thing . I'm not sure if I asked you .
P: No no chest pain.
D: OK. And in terms of your general health, do you? Do you have any chronic conditions that you live with?
P: Um no no.
D: Do you take any medications?
P: No.
D: OK, have you ever had any surgery or been hospitalized for another reason?
P: Um no.
D: Do you have any allergies?
P: No allergies.
D: Do you have any family history of respiratory problems, cancers or heart problems?
P: No, nothing like that.
D: OK. And just in terms of free lifestyle, so do you live with family?
P: Um no.
D: OK, do you read along with a partner or roommate?
P: I live with my parents and my younger sibling.
D: OK. And is that in town here?
P: Yes, yeah.
D: OK. And in general, do you eat a healthy diet? Do you exercise?
P: Yeah, I think so.
D: Do you smoke?
P: Uh no.
D: OK, do you drink alcohol?
P: Uh I I have drank alcohol before but not not regularly.
D: OK um. And I do use marijuana?
P: Um I have taken edibles before but also not very regularly.
D: OK, any other drugs?
P: No.
D: OK, and are you currently in high school?
P: Uh yes, I am in my last year of high school.
D: OK, and how is that going?
P: Pretty good, yeah, we're doing things online now.
D: So you haven't really been out of the house?
P: No.
D: OK. OK. Uhm I think that's all my questions for now. Uh I definitely like to get you a covid test just because your symptoms are consistent with some common covid symptoms. So basically that means that we would do a swab. It might not come back for a day or two. You definitely have to self isolate between now and when you get the results back, potentially even if it's negative, longer, if you're still having symptoms.
P: Yeah.
D: Otherwise, there probably. There might be a couple other tests we want to do. We might have more questions when we come back, we'll go over this with the doctor that I'm working with today, but just wanted to give you a heads up of what to expect next. Did you have anything else you wanted to tell me that I didn't ask you about or any questions?
P: No, uh thank you so much.
D: OK, well thanks for coming in today. Will definitely get you taken care of shortly.
P: Thank you.
D: K thanks. |
dataset\resampled_file\RES0011.wav | D: Could you start with telling me what brought you in today?
P: Hi, I've just been been so like weak and so tired, I just I can't I can't seem to like get off the couch, like I'll get up from my bed and go lay on the couch and then you know I might be able to get something to eat but I just I get so tired so fast and I don't know I don't know what's wrong.
D: OK, when did these symptoms start?
P: Um, like I've been feeling pretty tired for like a week, but like this bad for like maybe four days.
D: OK, um and so it sounds like you haven't been going to work or like anything like that because you have been so kind of tired and weak.
P: Yeah, I mean at first I was already kind of working. I'm I'm a truck driver so you know, once you start the job, you kind of have to finish that. I was supposed to go on another another trip like 4 days ago and I just couldn't. I had to call my boss and say that I can't.
D: OK, um have you had any like specific muscle weakness like in your legs or or in your arms? Or would you say it's overall like a general weakness?
P: It's just everywhere. It's it's not like I can't move. I'm just really, really tired.
D: OK, and how, how have you been sleeping?
P: I mean, I've just been sleeping like all the time. I have been sleeping all night and then like I said, I get up and I go to the couch and like just fall back asleep.
D: OK, uh, have you been having any other symptoms?
P: I mean my my throat is maybe a little sore, but nothing nothing else.
D: OK, uh, when when did the sore throat first start?
P: Probably probably about a week ago. It's not really bad, it's just kinda there.
D: OK, so it's it started just before uh, the weakness and fatigue?
P: Yeah, around the same time.
D: OK, um, and have you been having any pain with swallowing?
P: Uh, I mean maybe a little bit.
D: OK, like with uh, like solid foods or liquids or both?
P: It it's just like it's just like it's a little a little tender. It's not like, really it's not like hard to swallow or anything, it just feels like it's like my throat's kinda tired.
D: OK, have you had any changes to your voice?
P: Uh, no, I don't think so. I mean, I live. I live alone so I can't really ask someone else if I have.
D: OK, but your voice sounds the same to you?
P: Yeah, I think so.
D: Alright, um, and so have you been having any fevers or chills?
P: Um, I've been, I've been feeling really cold.
D: OK, have you had any, uh, like shakes or or rigors?
P: I've been like kind of kind of shivering.
D: OK, how about any night sweats?
P: Um, yeah, come to think of it, like I was I was, when I was last traveling with, when I was last on it because I'm a truck driver, I I was in the States, I I had to bring something to Ohio, and I had to change my clothes in the night. They were just like so drenched in sweat.
D: OK, has that happened more than that that one time?
P: Maybe a couple times that it wasn't as bad, that one time was really bad, but here and there like I I've been feeling pretty sweaty at night in general.
D: OK, and have you had any, uh, like difficulties breathing or shortness of breath?
P: Not really, just like kind of tired, but it's not like hard to breathe.
D: OK, um have you had a cough?
P: Uh, no.
D: OK, how about a runny nose?
P: Maybe maybe a little bit, but not like too noticeable.
D: OK, and when did the runny nose start?
P: Oh, it's all like around the same time.
D: OK and have you been having any headaches?
P: A little.
D: OK, and then how about any chest pain?
P: No no. No chest pain.
D: Alright, and how about any wheezing?
P: No, no, I don't think so.
D: Alright, then any heart palpitations?
P: No.
D: OK, have you felt lightheaded or or like you were going to pass out or faint?
P: Uh not like I've been feeling really tired, but it's not been like I don't think it's been like fainting.
D: OK, so kind of like you are fatigued that you've been experiencing. Um, have you had any abdominal pain?
P: I mean, I'm not really eating a lot, so it's kind of like gurgling.
D: OK, have you had any nausea or vomiting?
P: Uh, no.
D: OK, and have you had any urinary problems?
P: No.
D: Any bowel problems?
P: No, I mean, you know I haven't been eating that much, so I haven't been going as much as normal, but it's I don't think there's problems.
D: OK, so you haven't had any diarrhea?
P: No.
D: OK. Um, and have you had any skin rashes?
P: No, not that I've noticed.
D: OK, and um have you had any like muscle aches or or joint aches?
P: I mean, I feel kind of achy all over but not in like one particular spot.
D: OK. And in terms of your past health, have you been, is there any reason you you see a doctor regularly?
P: Oh Oh yeah, like I have I have high blood pressure and diabetes. Yeah, that's that's pretty well it, but yeah, those two things. Oh and I take a medication for my prostate.
D: Oh OK, um, and do you take medications for the blood pressure and diabetes?
P: I yeah yeah, I um, oh geez, what's it called? I take ramipril, and I take Metformin. I was on insulin but I pretty well I just have been able to eat well so I'm not taking it now. And then, uh, I can't remember the, uh, the prostate one. Like tam, tam something.
D: OK, maybe tamsulosin?
P: That sounds right, yeah.
D: OK, I can check on the chart as well to confirm. Um, do you have any allergies to medications?
P: No.
D: Alright, and any recent hospitalizations?
P: No, no, I've been pretty good.
D: OK, and any surgeries?
P: Uh, not for a really long time, I I had my gallbladder out like 20 years ago. Yeah, that's it.
D: OK, um, and has anything like this happened to you or any of your family members before, suddenly they start started to feel fatigue like this?
P: I don't think so. I mean, we've all like you know, caught colds and you know stuff like bugs and stuff but, not not quite like this, like I can barely get up.
D: OK, anybody in the family have a history of heart disease or cardiovascular disease?
P: My dad had high blood pressure, that's it.
D: OK, anybody in the family have cancer?
P: My mom, my mom had breast cancer.
D: OK, and you told me that that you work as a trucker, so you were over in the states, it sounds like. How recently were you in the United States?
P: That was like about a week ago. I probably got back five or six days ago.
D: OK, do you travel there often?
P: Oh yeah, yeah. I mean that's you know the route that I usually take.
D: OK, uh any anybody you interacted with that was sick, do you believe?
P: I don't. I don't really interact with with many people. I kind of just go there and um, and then you know I stayed in a hotel. But you know, I didn't really see anyone besides like the lady that works there. And maybe you know, the people at the McDonald's like counter. I didn't I didn't like see anyone that I know that I sat with for a long time or anything.
D: OK, but you got home about five or six days ago. Um, yeah, and who are you living with currently?
P: Just me.
D: OK, and do you drink alcohol?
P: Oh no. No, I used to a little bit, but not not anymore.
D: OK, and how about cigarettes? Do you smoke cigarettes?
P: I quit um 10 years ago.
D: OK.
P: I smoked I smoked probably like 1/2 a pack a day for for a while, maybe 20 years.
D: OK, but you quit over 10 years ago?
P: Uh, about 10 years ago, yeah.
D: OK, and do you smoke marijuana?
P: No no.
D: Alright, and how about any other recreational drug use, including the use of IV drugs?
P: No, nothing like that.
D: OK, and are you currently sexually active?
P: No no.
D: OK um, and have you had a sexually transmitted infection before?
P: No no.
D: OK uh, and are you currently in a in a relationship?
P: Uh, no, uh, like I have I have a friend that I see and we both, um, we both lost our spouses, um, several years ago, and I
mean, we, we see each other and like we live in the same apartment building and often have meals together. But we're just like friends.
D: OK.
P: But that's the person that would check on me if I needed it.
D: OK, that's great. It sounds like you have some good support nearby. I'm sorry to hear about your wife. But I think that was all of the questions that I wanted to ask on the the history today. So next I we're gonna order some some lab work for sure to start with then and maybe we'll go from there. So we'll give you some fluids, and maybe some Tylenol and we will see what the lab work shows.
P: OK, thank you.
D: Oh, you're welcome. |
dataset\resampled_file\MSK0033.wav | D: What brings you in here today?
P: I've been having this pain in my knee and it's been going on now for a few weeks. It's kind of right at the, I could feel it right below my kneecap and at first it it was really only bothering me after activity, but now it's starting to hurt during as well, and so it's, it's trying to limit my ability to play basketball.
D: OK, and so you said this started just two weeks ago?
P: Yeah, about about a few yeah few weeks ago.
D: OK, and has the pain so it's been getting a bit worse and with activity and it's right below your kneecap, is it the right way or the left leg?
P: Yeah, it's on the right side. It's my right right side. Yeah.
D: OK. And what kind of pain are you experiencing, is it kind of a sharp pain or is it a dull aching pain?
P: It's, uh, it's pretty achy.
D: Yeah, it take you. OK, and does the pain travel anywhere else or does it, it's just right below your kneecap?
P: It's right below my kneecap, yeah I feel like it's just over a kind of a small area it's a pretty specific spot and if I press on that area at all it gives me a pretty, it's a sharp pain if I if I press on it sharp pain.
D: OK. And on a scale of zero to 1010 being the worst pain you felt in your life, how much would you rank the rate this pain?
P: I it's about about a six or seven.
D: Six or seven OK. And is it a constant pain, or like do you get the pain when you're not playing basketball or doing other activities?
P: Um I'll get it if I'm. Like sometimes I'll feel it if I'm going upstairs like walking upstairs or. Like if I'm sitting for a long, long time and I I get up, it'll feel a bit sore. But it's mostly if I'm like doing activities like running or jumping, doing like strenuous stuff like that.
D: OK I see, an has this ever happened before?
P: No, I haven't had any any issues with my knee before.
D: OK. And otherwise, are you having any other symptoms besides the pain, like any numbness, tingling?
P: No, nothing like that. It's just the pain.
D: OK, and any weakness in your legs?
P: Um no, no weakness.
D: OK, and uh. Have you tried anything that improves the pain at all or anything that makes it worse?
P: Um I I have tried taking some like Tylenol and Advil and that or or and NSAIDs that and it has helped with the pain. I've tried icing it too, like after practice and stuff like that which does seem to help a little bit, but uh. Yeah, that's about it.
D: OK. OK, and other than that, did you like have a fall or did you have any injuries recently before you started having this pain?
P: No, it's kind of come on on its own, no falls or like trauma to the knee.
D: OK. And other than that, are you healthy, do you have any medical conditions at all?
P: Um, yeah, I don't have anything I am healthy.
D: OK, any medications that you take on a regular basis?
P: No, not not. Nothing. I don't take anything.
D: OK. Any allergies?
P: No allergies.
D: OK, and have you been sick recently at all with fevers, chills, any cold or viral symptoms?
P: No, I haven't had anything like that. I've been feeling well.
D: OK, uhm. Any changes in your skin, like any rashes?
P: No, I haven't had any any rashes.
D: OK, and any kind of shortness of breath, chest pain?
P: Nope, nothing like that.
D: OK. And any changes in your bowel movements or urinary patterns?
P: No, I haven't had any changes there.
D: OK, OK. And do you have any recent or like past history of any hospitalizations or surgeries?
P: No, I I haven't had anything like that.
D: OK, and any family history of any musculoskeletal conditions or any anything that runs in the family?
P: No, not nothing like that, no.
D: OK, OK. And currently right now. Do you do you go to school or do you work at all?
P: Yeah, I go to school. And, uh, I play on the, uh soccer team and the basketball team. It's basketball season right now. And, uh, in grade 10.
D: OK in grade 10 OK. And school going well, any issues at all with bullying or anything like that?
P: No school's been been going well. I have been doing well in my courses and have a good group of friends so I enjoy it. It's fun.
D: OK. And what's your home situation like, do you, who do you live with?
P: So I live with both of my parents and I have a a younger sister as well. She's in grade grade 7 and we have a dog as well.
D: OK, and do you generally feel safe at home as well as outside of your home environment?
P: I do, yeah my I get along well with my parents and we. Yeah, but my parents are great.
D: That's good and and this is just wanted to let you know that anything that you talk about in here with us stays confidential and won't leave this room unless there is potential harm to yourself or others. So have you tried any recreational drugs like marijuana, have you tried smoking or alcohol at all?
P: No, I've been trying. I stay away from that, that sort of thing. I've I know about other people in my class who have and stuff, but I always just, I'm just trying to stay as ready as I can for the sports.
D: OK, that's good. And yeah, so and are you up to date with all your immunizations?
P: Yeah yeah, my mom made sure that I got all of that stuff done.
D: OK. Alright, so yeah, those are some questions I had. I just have a few more questions with regards to just examining your knee. Are you able to walk or do you have any kind of a limp?
P: No limp I can. I can walk OK.
D: OK and are you able to run?
P: Yeah I can. I can run, but when I do it it causes some pain. I'm able to still run but yeah it it hurts.
D: OK and. So when you palpate your lower knee just under the patella, you said it's a sharp pain, right?
P: Yeah exactly and then when I it's, and it feels kind of achey or when when, like after practice or something like that, but if you press on it it it's sharp.
D: And, uh. Any any kind of like are you able to flex and extend your knee right now if you tried?
P: I can yeah.
D: OK and have you noticed any kind of rotation of your knee at all?
P: No, nothing like that.
D: No OK. OK, and no weakness below your knee, right?
P: No weakness. I just feel like my muscles are really tight like my fly and my hamstring muscles. Think I need to stretch them out some more, they do just feel tight.
D: OK, and do you notice any kind of swelling or redness or bruising in the area?
P: No.
D: no OK, and your ankle and hips you don't have any pain or issues with movement, right?
P: No, not at all. No, no problems with my ankle or hip.
D: OK alright yeah. So those are just all the questions I had for you today. Do you have any questions?
P: I was just wondering what I can do to make this go away.
D: Yeah, so definitely this is something that is what we call Jumpers knee. It's fairly common, uh, amongst younger athletes, especially those that play sports like volleyball or basketball. But right now we don't really need to do any kind of imaging or anything like that. It seems like you're in the earlier phases and it's good that you came in. We definitely do need to manage it with some conservative management where we're going to keep having taking a look at it as well as I would recommend icing it every, like for half an hour, like around four to six times a day, especially after you're doing your activities. Then you can you can take the, continue taking the Tylenol and Advil, as well. As long as you're following the maximum amount per day depending on if you're taking extra strength Tylenol for example versus the regular strength. And then I will also refer you to some physiotherapy that will kind of a teach you some strengthening and stretching exercises that you can do to help what we call like that you will you might be having is just um some inflammation in your patellar tendon, right below your patella. So we need to strengthen the muscles around it. So we'll do some referral to physiotherapy and then we'll see how you you do based on all those treatment options and then if it gets worse and if or if it doesn't get better, we might need to do some imaging, either ultrasound or an MRI and then see where to go from there. But for now does that sound OK with you?
P: It does, yeah, thank you. So you said that you think it's like a patellar tendonitis or something like that?
D: Yeah, it's patellar tendonitis is commonly called the jumpers knee and it should resolve with the steps that we, especially since it seems like you're in the earlier stages. So it seems like it should be pretty responsive, but if it isn't, there are other steps we can discuss in the future.
P: OK, that sounds great. Thank you. |
dataset\resampled_file\RES0204.wav | D: I hear that you have been having some coughing so I'm just going to chat with you for a bit get an idea of how things are going well, have a listen to your lungs in your heart and then I will go grab the doctor that's working today and we'll talk about it and then we'll come back and let you know what the next steps are going to be. That does that sound good to you?
P: Yeah, that sounds great. Thank you.
D: Can you tell me about what brought you in today?
P: Yeah, I've had this cough for the past four or five days and it doesn't seem to be going away or getting better, so I thought I should get it checked out.
D: OK, are you here with your mom today?
P: I am.
D: Hi mum. Um OK. You got a cough you said I'm sorry, you said for five days?
P: For, yeah, four to five days ish, yeah?
D: OK. And, uh, has it you said it was a dry cough? Is that right?
P: Yeah, that's right.
D: OK, so at no point were you bringing up on gunk with your cough?
P: Yeah. No, no, nothing like that.
D: OK. Since it started, do you think it's gotten worse or has it kind of stayed the same? Gotten any better?
P: It's kind of stayed the same.
D: OK. OK, uhm. Along with the cough have have you been having any other new symptoms?
P: Uh no.
D: OK, have you had a sore throat?
P: No.
D: Do you feel like you can taste and smell things normally?
P: Yeah, I think so.
D: OK. OK, have you been having a runny nose?
P: Oh yes, I have had that for the past couple of days as well.
D: And is it a runny nose with kind of clear stuff? Is it watery or is it thick? Does it have a color to it a yucky the color?
P: It's pretty clear.
D: OK, OK. Uhm. And uh have you had any fevers? Your mom might be able to answer that one better.
P: Yeah, um. He has had uh like he's had fevers in the past, but I I didn't really check this time. He didn't seem hot. He didn't have any chills.
D: OK, well that's good. Uhm. OK, have you had any back or muscle pain?
P: No.
D: OK. Have you had any chest pain?
P: Uh no, no chest pain.
D: OK. Any, any nausea or vomiting?
P: Uh no, no nausea or vomiting.
D: Have you ever had any pain in your belly?
P: No, nope that no pain in my belly.
D: Any headaches?
P: No, no headaches.
D: OK, have you been around anyone that's been sick?
P: No, not that not that I can remember.
D: OK. Uhm, have you traveled anywhere recently?
P: Uh nope.
D: Are you going to school right now or staying home?
P: I’m going to school and they're doing these half days.
D: OK. OK uhm, and has anyone in your school been sick?
P: Ah, Nope, not recently.
D: At least not that we know of. OK.
P: No.
D: OK, have you ever had anything like this before?
P: No. I've been pretty healthy otherwise. I've never had like I've never had like a dry cough like this. I've had runny nose in the past, but they never lasted this long.
D: OK, have you ever been in the hospital?
P: No.
D: OK. Did you see your family doctor for anything? Any health problems?
P: No, no.
D: Do you take any medicines?
P: No.
D: OK. This may be a tricky one to answer, so Mom can definitely help us. Do you have any family history of respiratory problems?
P: Um uh his grandparents had um asthma, but he's been worked up for that and he doesn't get short of breath or wheezing or anything like that with even with physical activity. So yeah, so he doesn't have that.
D: And what else?
P: Pardon me.
D: I said just some some asthma in the family.
P: Yeah.
D: OK. And so you live, you live with your mom. Do you live with anyone else in your family?
P: I have a four year old sister.
D: OK, do you live with your dad too?
P: Yes.
D: Do you guys have any pets?
P: Um no, no pets.
D: And does anyone smoke in the home?
P: Nope, no.
D: OK, and what do you like to do for fun?
P: Um I like playing with my friends, I like playing video games.
D: Oh cool. So what's your favorite game?
P: I am playing Rollercoaster Tycoon.
D: Oh cool, that sounds like fun. OK well, hopefully we can get you back to feeling healthy so you can continue to play lots of roller coaster Tycoon. So I’m going to go get the doctor that I'm working with. I'm, uh, I'm wondering, you know, he might want to do a chest X Ray and get a better look at what's going on there. Have you ever had an X Ray before?
P: I don't think so, no.
D: Do you know what an X Ray is?
P: A little bit, yeah.
D: Yeah it's like taking picture of your body on the inside. It's pretty cool so it gives us an idea of what's going on in the inside. Also, this really this part is kind of not so much fun, but I think we should probably do a covid swab because we're doing that with anyone that comes in with these symptoms lately and that's not a lot of fun. We gotta stick something up your nose, but I think that you're really brave and I think that you'll be just fine with it, OK?
P: OK.
D: So we're going to arrange for these things and then I will come back with the doctor that I'm working with and we'll kind of talk about where to go from here.
P: OK, that sounds good.
D: Thank you guys for chatting with me.
P: Yeah, thank you.
D: Thanks. |
dataset\resampled_file\RES0170.wav | D: How may I help you today?
P: I'm just bringing my son today because he's been how many episodes where I'm eat hell gets all this coughing fit and become wheezy and become shorter breath and I mean after a period of time it goes away, but it's been happening every so often.
D: Does he still have these symptoms?
P: Like right now he's OK. When the symptoms come on, they last for I don't know, maybe 30 minutes, 60 minutes or or even less. But yeah it happens maybe once or twice a week where and it's been going on for a, a couple of months now. Yeah, he actually had a viral infection like a few months ago and I thought it was just that. It leared up and then he's just had a few more of these episodes, but without those kind of symptoms so.
D: Hm? So all this started a couple months ago.
P: Yeah.
D: Do you find that there and you mentioned that it happens about one to two times a week? Is there anything specific happening at that time? Any triggers that result in these symptoms?
P: Well I will say I think I like exercise. I find yeah like soccer practice. Yeah, after maybe, or even during a game, like when things are really intense. Yeah, I think during soccer I've I've kind of noticed it. And then at night time as well. It kind of randomly, he'll have this cough.
D: OK. So I guess it's do you feel like it's affected by cold weather as well or no?
P: Um, maybe yeah, like if he yeah completely in the winter time. Like I know when he goes outside if he yeah he takes like a deep breath or something like that. He'll talk about having shortness of breath or difficulty breathing in the cold weather.
D: OK, other than the and I guess the cough. Is he coughing up anything, or is it kind of a dry cough?
P: It's dry.
D: OK. Does he have any like chest pain during these episodes.
P: No, he hasn't said anything like that.
D: Alright, any fevers?
P: No, he had a little bit of a fever at the that one time a few months ago, but he hasn't. So that's right. I think he had a some sort of illness then, but he hasn't had any fevers.
D: I see. OK, any headaches?
P: No, he hasn't said anything like that.
D: OK. And how has he had any other symptoms so anything like racing heart or belly pain or muscle aches or any changes in his bowel movements or urinary symptoms?
P: Uh no, I haven't heard him, uh, I complain about anything like that. I think I'll everything like that's been normal.
D: OK. So when he has these episodes, how like how severe are they? So how difficult is it for him to breathe?
P: Ah, well, you certainly when it first starts, I mean for the first minute or two. Yeah, he that when I think particularly at soccer practice school have a really hard time catching his breath, but like he would, he stops playing and rests and really tries to make sure that he is I don't know, just trying to to breathe and it kind of goes away. He's been able to manage it OK.
D: OK, alright and I have these symptoms that have interfered with his daily activities? Does he for instance, try to avoid soccer practice. Or does he have difficulties falling asleep at night?
P: Yeah, definitely wakes him up a few and every once in awhile at night and he does have to take it a little easier at soccer for sure. So yeah, I am thinking it is affecting him.
D: OK. And otherwise has he been, has he had any medical conditions that he's been diagnosed with?
P: Uh, no, well he had some rashes when he was younger that he would get some some creams for, but that's mostly resolved now.
D: OK, any hospitalizations or surgeries?
P: No, he hasn't had anything like that.
D: OK, uhm. And just going back to his birth and your pregnancy, were there any complications at the time of pregnancy?
P: Um, there was a prolonged labor, I think, but he was delivered vaginally and at term
D: OK. OK, that's great.
P: And he, oh sorry, I was just going to say normal weight as well.
D: OK good has, was he kept in the in ICU for a couple of days after, was he sent home?
P: I think they, like he was kept for not an ICU he was kept for one day I think so just monitor for infection because it was like prolonged labor but he was OK. OK, so yeah we were able to go home.
D: OK, and I, what was I going to say. Forgot what I was going to say. How yeah, how has this growth and development been? Has he been seeing his doctor regularly? Any concerns there?
P: Yeah he's been good with with growth. No concerns for that and his developments been normal as well. He's reached all of his milestones.
D: OK, and is he going to school?
P: Yeah, yeah, he's been going to school. He hasn't really been, he hasn't missed well he's missed one or two days actually, because of the cough, like on nights that he just didn't sleep well, so in the morning he's just well, not not feeling good for school so he has missed a couple of days over the last few months.
D: Okay. And does he, is there any other any conditions that run in the family? Including things like asthma or eczema, or allergic rhinitis or allergies.
P: Yeah, sister does have some bad allergies. Her nose runs all the time and she also has that asthma. His sister uses and a daily inhaler and then also W1.
D: I see. OK, and uh. How are things at home is he, is he doing well otherwise? Like at school and things like that, any stressors in his life?
P: No, he's been doing, uh, he's been doing well at school. He likes math and that that's been going, well.
D: OK, great. Has he ever tried any puffers?
P: No, he hasn't actually.
D: Has he been on any medications?
P: Um, he he has not.
D: Any allergies that he has?
P: Not that I'm aware of, but I I think he might. I mean so like environmental or I don't know, something. He does get symptoms like a runny nose and itchy eyes sometimes, but usually go away pretty pretty quickly and he doesn't fuss about it too much so, yeah so.
D: From the symptoms that you've described so far, it sounds like he might also have asthma, but we will obviously have to do some testing and confirm that. Uhm, and also, it's given sort of the results, or even just like giving his symptoms, prescribe some buffers to help with those symptoms. Clearly it's affecting his life. He can't go to school or can't participate in soccer, or sometimes wakes up in the middle of the night, and that's not good. So, we'll we can be prescribed some puffers and see if those help and also get some testing done. Do you have any other questions for me?
P: Uhm, No, yeah I was just wondering about, so like the wheezing and all of that could be with from asthma too?
D: Uhm, yeah, I would think so, but again, we'll get the testing done and see if there are any other, any other causes.
P: Ok.
D: You said the wheezing sort of lasts only 30 to 30 minutes to an hour and then gets better?
P: Yeah, I don't notice that any other times.
D: Yes, it's possibly, I mean, I would think it's asthma, but then we'll get the testing done and see.
P: OK, great, thank you. |
dataset\resampled_file\MSK0024.wav | D: What brings you here today?
P: Hi, I've been having this back pain for the past month, so I'd just like something for it an and you know image it if possible just to figure out what it is.
D: You've been having it for the last month, is this the first time you're having this back pain?
P: Yeah yes.
D: OK and where exactly are you having the back pain?
P: It's in my lower back.
D: OK, and what kind of pain are you experiencing, is it like a sharp stabbing pain or is that a dull aching pain?
P: It's kind of dull and achy but sometimes I feel like I have little spasms in my back.
D: OK, and how often are you getting these spasms?
P: Um I'd say like two to three times a week.
D: OK. And it is this back pain constant, or does it come come and go?
P: It's pretty constant, but it gets worse with certain things.
D: So one month ago when it started before then, did you injure yourself at all or, were you doing anything that brought on the pain or did the pain come on gradually?
P: So I work in this factory where I move a lot of boxes and I think I may have like lifted a really heavy box or lifted it in an improper position because that's when, that night is when my back started hurting.
D: OK, I see and how long have you worked in this role?
P: For the past 30 years.
D: OK Alright. And has the pain become worse at all or has it stayed the same since it started?
P: I'd say it's pretty. It's been pretty similar to the start.
D: OK. And does the back pain move anywhere, like for example does it shoot down your legs at all?
P: No OK. Have you tried anything that has helped you?
P: I've tried some topical analgesics, and you know those fire and ice gels and I think sometimes that helps, but it's always temporary.
D: OK. And what kind of things make your pain worse like, bending down as opposed to stretching backwards?
P: Yeah, bending down like it when I flex my back that hurts more than if I straighten it out.
D: OK. Is a bending hurts more and what about bending towards the sides?
P: Um a little bit more towards my right side.
D: OK. And are you having any other symptoms, like numbness or tingling in your extremities or back at all?
P: No.
D: And any kind of numbness or loss of sensation in your buttocks area or just below your lower back?
P: Um no
D: OK. And any fevers or chills?
P: Nope.
D: Any night sweats?
P: No.
D: Any um skin changes or rashes?
P: No.
D: Any, have you been ill recently at all with cough cold symptoms at all?
P: No.
D: Do you feel pain in anywhere else, in any other muscles or joints at all?
P: Um no.
D: Have you recently had any changes to your weight?
P: No.
D: OK. And. Any kind of changes to your bowel movements?
P: No.
D: OK. Any kind of issues with urination at all?
P: No.
D: And any urinary or fecal retention or incontinence?
P: No.
D: Right, so it's just this pain that's been there for the last month, stayed around the same. In terms of your medical history have you been diagnosed with the. Have any medical conditions in the past?
P: I have a high blood pressure which I take some Ramipril for.
D: OK. Any allergies to any medications?
P: No.
D: OK and have you are using any other medications at all?
P: No.
D: Have you been hospitalized or had any surgeries in the past?
P: No.
D: OK. Do you have any family history of any musculoskeletal or rheumatologic condition?
P: No.
D: Any cancers in the family?
P: No.
D: And so currently are you working or did you have to take time off work?
P: I'm taking some time off work until I figure out what this back pain is.
D: OK. And currently, what's your living situation like?
P: I live in an apartment with my wife and our teenage son.
D: OK. And do you smoke at all?
P: I used to smoke. I haven't smoked in over 10 years.
D: OK. And do you drink alcohol at all?
P: I drink occasionally, I'll have like a beer on the weekend.
D: Any recreational drugs like marijuana?
P: No.
D: OK. Alright, so I'm just gonna ask a few questions, maybe get you to do some movements and see what hurts the most.
P: OK.
D: So when you press your hand down, down your spine. Is it hurt at all in the lower back with palpation?
P: Um it kinda hurts right in the middle, uh, just above the buttocks area an where like my tailbone almost is
D: I see. And, uh, any kind of pain with lying down and then raising your legs straight up without bending the knees.
P: I can try that. Um that hurts a little bit, yeah.
D: And does it hurt in the lower back or near the front of your hips?
P: That hurts in my lower back.
D: And any kind of redness or swelling that you've noticed at all? I know it's in the back, so it might be more difficult to see.
P: Um no, I don't see anything like that.
D: OK. And are you, has your gait, changed at all, or is it, are you able to walk without a limp or anything?
P: I'm able to walk without a limp.
D: OK. Alright, so and then, uh, bending down you said hurts more than standing up or extending your back, right?
P: Yes.
D: OK. Alright, so those are all the questions I had for you today. Do you have any questions for me?
P: No, just like how can I treat this?
D: Yeah, for sure. So this has been going on for the last month. It sounds more like what's called mechanical back pain and due to the nature of your work having been lifting heavy objects for the last 30 or so years it's usually something that occurs with repetitive, repetitive work, and strenuous work like that that affects your back. And what you're describing with the flexion seems more pain coming from the discs themselves instead of the facets at the back. So every time you flex you have some compression of your discs. So what we what we need to do right now is it's been one month almost and then usually we get imaging if the pain does not improve after six weeks of conservative management. So what we can try is to give you some pain management first, and some anti-inflammatory medication, and then as well as try some physiotherapy, some exercises to help you with the back pain. And then if the pain does not improve and since there is no red flags that were too worried about right now with your back pain we can wait to get some imaging. But first we would just like to try some of the conservative management. Is that OK with you?
P: Yeah, that sounds great. Thank you.
D: You're welcome, alright take care. |
dataset\resampled_file\RES0026.wav | D: I was wondering if we could start with you telling us what brought you in?
P: Sure, I've had this terrible headache for the past four days. Doesn't seem to be getting any better, and I feel hot like I have a fever. I've been coughing a lot so I am I'm worried I have COVID, so I'm here.
D: OK. So I'll start with the headaches. When did when did that exactly started?
P: Uh the headache started, OK so the coughing started four days ago. The headache started shortly after so I would say later on during that day and then the fever I've had for, fever I think I've had for the past two days. I haven't actually taken my temperature though.
D: OK um. So, uh, the cough is started four days ago. Has the cough gotten better, worse, or stayed the same?
P: The cough has stayed the same.
D: OK, are you bringing up any phlegm or sputum with the cough?
P: Um, it's not really phlegm, but sometimes I cough up, like bits of like. You know little bits that look like blood or something.
D: OK, so you're seeing some like red when when you're coughing up?
P: Mmmm
D: OK, and how much of this are you seeing like, is it like a teaspoon amount or or more?
P: Oh, it's it's very little. It's like maybe a little bit bigger than like the tip of a pencil.
D: Oh OK, are you, OK, are you seeing this on like kind of tissues afterwards sort of thing?
P: Yeah.
D: OK, um and any triggers for the cough you can think of?
P: No, it just seems to be there all day. Um, doesn't really get better with me trying to rest or not.
D: OK, and is the cough there at night time too?
P: Yes, it is definitely there at night.
D: OK, um is it interfering with sleep?
P: Ah yes, I haven't been sleeping well.
D: OK, um, and with your cough have you had any difficulties with breathing?
P: Um, no.
D: Alright, and now, how about any wheezing?
P: No wheezing.
D: OK. And with this headache when it first came on, did you experience a like worst headache of your life, or a Thunder clap sensation?
P: No, it's it's not that bad, but it just seems to be there all day long.
D: OK, um have you had headaches like this before?
P: No, I've never gotten headaches in the past.
D: OK, uh is the headache associated with any nausea or vomiting?
P: No.
D: OK, and is the headache worse in the morning when you first wake up?
P: No.
D: OK, and does it have to get worse if you lie flat?
P: No.
D: OK, and has this headache been getting worse, staying the same, getting better?
P: It's it's about the same.
D: OK. Um and, um and you haven't checked the temperature yet, you said, but you felt hot?
P: Yes, that's right.
D: OK, any other symptoms that you've been experiencing?
P: Not that I can think of.
D: OK, there's just a few others that I wanted to ask about to be comprehensive. Have you had any eye pain or ear pain?
P: No.
D: How about any discharge from either your eyes or ears?
P: No, nothing like that.
D: Alright, have you had any changes to either your sense of smell or your sense of taste?
P: No.
D: Alright, and have you had a runny nose at all?
P: Um no.
D: And how about a sore throat?
P: No.
D: OK, and um, have you had any chills?
P: Um no chills.
D: How about night sweats?
P: Um no nothing like that.
D: I see, OK and over the last few months has your weight changed?
P: Ah no, not that I noticed.
D: OK, um have you been feeling tired or fatigued?
P: No.
D: OK, and have you had any chest pain?
P: Um no.
D: Alright, and how about any heart palpitations?
P: None.
D: Alright, in any episodes of feeling really dizzy or lightheaded.
P: No.
D: OK, and how about any fainting spells or feeling like you might faint?
P: No, nothing like that.
D: OK. And have you had any abdominal pain?
P: Um no, no abdominal pain.
D: Any diarrhea or constipation?
P: No.
D: How about any painful urination or feeling as though you need to urinate really frequently?
P: Ah no nothing like that.
D: OK, and have you had any skin changes like rashes or anything like that?
P: No.
D: OK, and how about any muscle aches or joint aches or just overall like body pains?
P: Mmm no, not that I that not. Not that I've noticed, no.
D: OK, is there anything in regards to your past health that you see a physician regularly for?
P: Um No. Ah actually I I think at one point, um, I was worked up for something called familial hypercholesterolemia because it ran in the family. But I think those results were normal.
D: OK, so do you, um, do you take a statin medication then?
P: Yeah I take a low dose statin.
D: OK, and when was your last lipid panel checked?
P: I think it was two years ago.
D: I see, and um do you remember if the LDL was normal at that time?
P: Ah yes it was normal.
D: OK, but since the, it was about two years ago, it might be worthwhile today just to also check a lipid panel just to be safe, but that'll be something we can talk about that more so at the end if that's OK.
P: Sure, yeah, that would be great.
D: OK, and any other medical conditions?
P: No.
D: OK. Have you had any surgeries before?
P: C-section.
D: How many children do you have?
P: Ah just the one.
D: OK, and were there any complications with the c-section?
P: Um no no complications.
D: OK, any reasons for hospitalizations?
P: Nope.
D: OK, any allergies to medications?
P: No.
D: Alright, any medications besides the statin that you take?
P: Nope.
D: OK, and in regards to your family history, have there been people who've had early heart attacks or strokes in the family?
P: No.
D: OK, but you do have familial hypercholesterolemia, do you have family members who have that?
P: Yes OK so my Aunts had it, as well as my mother.
D: OK um. And has there been any lung conditions that run in the family?
P: Um, no lung conditions.
D: How about any malignancy's or or cancers?
P: Ah there was colon cancer on my dad side of the family, but I'm not too sure who had it.
D: OK, have you heard of anybody having breast cancer?
P: Breast cancer no.
D: Alright, and how about ovarian cancer?
P: No ovarian cancer.
D: OK. And next I actually wanted to ask a few questions about your personal and lifestyle habits, but first, could you just tell me a little bit about your living situation right now?
P: I live with my husband and my one son.
D: OK, and sorry, how old is your son?
P: He is 10.
D: OK, um is anybody in the home been sick recently?
P: No.
D: OK, and how about is there anybody at work?
P: At work no. No one's been sick.
D: OK, have you traveled anywhere recently?
P: We went up to we just went to um like a, we went on a hiking trail that was outside the city recently and there were a lot of people there and and we weren't wearing masks, but we, it seemed like we were keeping a good distance between each other so that that would be my only concern.
D: OK for sure. Were people pretty close to each other on the paths when walking by on the hike?
P: Ahh not like the whole time, but there would be times when you know people just kind of brushed by you to try to get ahead of you or something like that.
D: I see OK. And do you smoke cigarettes?
P: No.
D: Um, do you smoke marijuana?
P: Um no.
D: OK, and do you drink alcohol?
P: I don't.
D: Do you use any other recreational drugs?
P: Um no.
D: OK, so that was all I wanted to ask about. Oh, actually one thing that I I did want to, I forgot to ask was, do you have any neck stiffness?
P: No, not that I noticed.
D: OK. So that was the last question that I wanted to ask about. Was there anything that you wanted to tell me that I I maybe forgot?
P: No, I think you covered it all. I'm just wondering do you? Do you think it's COVID or something else?
D: Well, it's definitely a possibility with the symptoms that you're having, since they can be so non- specific for covid it can be a lot of symptoms that overlap. So with having headache what sounds like you might have a fever and and this cough that sounds like it's pretty bad if you're bringing up some blood, it sounds like you might have irritated some of the bronchioles with the the coughing. So we will test for that and check a PCR nasal swab for COVID. I'm not, but we will also test for other viral illnesses and bacterial illnesses as well. It doesn't sound like you have meningitis right now just based on the symptoms where you don't have neck stiffness, but it'll be certainly something that we keep keep in mind while we are doing our investigations.
P: OK great, thank you.
D: Alright, you're welcome. We'll get those started.
P: OK, sounds great. |
dataset\resampled_file\RES0176.wav | D: How may I help you?
P: I um. I just haven't been feeling very well over the past couple months. And I have decided I just come in and see what's happening, so I've just I've been feeling short of breath. And I kind of passed out sometimes and I'm really worried about it.
D: OK. Uh, so when the shortness of breath start.
P: I say about five or six weeks ago.
D: OK, and and do you get short of breath at rest?
P: No.
D: And has it been getting worse or staying the same?
P: Uhm? Kind of the same maybe a little bit worse, but I yeah maybe the same. Definitely not getting better.
D: OK, how far are you able to walk or exert yourself before you're short of breath?
P: I can walk quite a bit, um, but I, I guess like when I go for my my runs in the morning, I start feeling short of breath. It's maybe like, two blocks or three blocks.
D: OK, and any any symptoms where you get short of breath at night and where you had to get up and and put your feet over the bed?
P: No.
D: Are you able to lay flat without being short of breath?
P: Uhm, yeah
D: Or does it.. OK. And every had any swelling in your feet or ankles.
P: No.
D: OK, and you mentioned that you you passed out as well. Can you tell me a little bit about a little bit about that?
P: Yeah, uh, it just happened two or three days ago. And I was just, I was-I wasn't really doing much I was I guess just like going up the stairs. And when I got to the top, I just kind of suddenly collapsed. And then I got back up.
D: Were you really short of breath at the top of the stairs?
P: I felt like my heart was like beating kind of fast. And I felt little bit dizzy.
D: OK, see, where you sweaty at the time as well?
P: I don't remember, maybe?
D: OK, did you feel like you were going to pass out?
P: Yeah.
D: OK, has anything like that happened to you before?
P: No. No.
D: OK and did you bite your tongue during this or?
P: No.
D: OK, and did you wet yourself at all? Like pee your pants or anything like that?
P: No.
D: OK. And how long did it last for?
P: Maybe a couple of seconds, it's. Yeah. I don't know, I I can't really tell. I was alone at home at the time. And I'd like I couldn't tell how long it took for me to get back up.
D: OK, you picture that your heart was racing. Did it feel like it was like did you have heart palpitations or is your heart beating really fast?
P: Yeah it was.
D: OK. And did you hit your head or or hurt yourself when you fell?
P: No, no.
D: OK, and recently, have you been otherwise feeling well or if you had any viral infectious symptoms like red eyes or itchy eyes or runny nose, sore throat?
P: No.
D: OK, nothing like that and have you had a cough?
P: No.
D: OK. And have you had any wheezing?
P: No.
D: And if you had any chest pain.
P: No.
D: OK, have you had any instances where you felt as though you were having heart palpitations at any other times? And not just during the time that you had the fainting episode?
P: Um, I kind of did when I was. When I was like running outside, but I just thought maybe maybe I was exerting myself too much.
D: I see, alright. And any chest pain?
P: No.
D: And. Uh, OK. Have you had any, any nausea or vomiting?
P: No.
D: Any abdominal pain?
P: No.
D: Any urinary problems?
P: No.
D: OK, any muscle aches or body pains?
P: No.
D: Any fevers or chills?
P: No.
D: Have you had any changes to your weight in the last several months?
P: No.
D: Have you had any changes to your appetite?
P: No.
D: And have you notice any skin changes like rashes or or anything like that?
P: No.
D: OK. And. Uh. In the past, have you been diagnosed with any medical conditions?
P: No, I've been very healthy.
D: OK, I do you so do you take any medications, either prescribed or over the counter?
P: Uhm, I just take some puffers for asthma, but I haven't had asthma in awhile. I actually thought maybe my asthma was getting worse over the past two three months. I didn't really. I just I didn't think too much of it. But then when I fainted, I was just kind of scared.
D: Yeah, for sure. Umm, certainly would be frightening. OK, and do you use the inhaler everyday?
P: No. I used to when I was young. I didn't have asthma for a couple of years for like, I'd say 20 years or so. So then I stopped taking inhalers.
D: OK, so you haven't used them recently.
P: No.
D: And any allergies to medications or, uh, environmental?
P: No.
D: OK, and if you had any hospitalizations or surgeries?
P: No.
D: OK. And have you been pregnant in the past?
P: Uhm, I I was yeah. I have a son. About eight years ago. He was born eight years ago.
D: Ok. Was this a vaginal delivery or a C-section?
P: Vaginal.
D: And any complications, either during pregnancy or delivery or afterwards?
P: Oh no, everything was good, no problems.
D: OK, and could you tell me a little bit about where you're living and and who you're living with?
P: Yeah, I'm living with my husband and my son. We live in a house about 30 minutes from here.
D: OK, uh, has anybody been sick in the house?
P: No, everyones been well.
D: Alright, have you traveled anywhere recently?
P: No.
D: OK, any exposures in the house like carpets or rugs or it's like like things like that?
P: We do have carpets, but I mean I, I don't think that's a problem. Like we've had it for like years and we've had the same carpets for years and years.
D: OK, I see and are you working currently or or at home?
P: Yeah, I'm at home but I work from home. I'm a writer.
D: OK cool, yeah I do you smoke cigarettes?
P: No.
D: Do you smoke cannabis or use any cannabis products?
P: No.
D: OK, and do you drink alcohol?
P: I do, I'll just drink on the weekends.
D: OK, and I like how many drinks would you typically have in a week?
P: Uhm, not much. I'd say one or two glasses of wine.
D: OK, do you use any recreational drugs?
P: No.
D: OK, And like you said, you're a writer currently. In the past, did you work any jobs where you were exposed to asbestos or like any chemicals or fumes in the air?
P: No, no, I haven't.
D: OK, And in the family is there is there anybody who has any heart or lung conditions?
P: No.
D: How about any clotting disorders or or cancers?
P: Uhm, prostate cancer. My uncle had it.
D: I see, OK. So it sounds like over the last little month, you've been having some more short shortness of breath as well as well this fainting episode more recently. So we will. Was there anything else that you wanted to add?
P: Hum, no.
D: Alright, so we will do some pulmonary function testing and get some imaging of your lungs today as well as an ECG and maybe a monitor for your heart as well to just check your heart racing for the next 48 hours. Mentioning that your heart was racing and so to rule out that any abnormal rhythms of your heart, or to check for that. And we will kind of go from there, did you have any questions?
P: No. |
dataset\resampled_file\RES0096.wav | D: Uh, how can I help you?
P: Uh, I have just been feeling very short of breath recently.
D: OK.
P: And I thought I should come in. I've also had a, I've also had a cough.
D: I see. OK, uhm, and when does this shortness of breath, uhm, come on? How, how much activity are you able to do?
P: Uhm, I can walk a block.
D: OK.
P: Without being short of breath.
D: And prior to this change, how far were you able to walk and and how long ago did you, did you notice this change?
P: Uhm, I, I guess I could walk, uh, I don't know, it's been very, I guess it's, it's been a gradual change. Uhm, maybe a month, a month ago I felt that I couldn't really walk as much as I used to, and then it's only gotten worse. Two or three months ago I could, I could walk a kilometre or two, or more.
D: OK, so quite a significant change over the last little while. Have you had any episodes where you wake up in the middle of the night with, with shortness of breath, and you need to sit up?
P: No.
D: OK, and how many pillows do you sleep with?
P: One.
D: OK and have you noticed any like ankle swelling or or leg swelling?
P: No.
D: OK. And you mentioned cough. When did that start?
P: I've had a cough for a while, the past five, ten years, but I feel that it's been a little bit more frequent now. It's just, I just get into this coughing fit and I think there was a time when I had a little bit of blood come out as well, once or twice. The coughing also makes it difficult for me to breathe, you know, I feel very short of breath after that.
D: Yeah, certainly, uhm, how much blood have you coughed up?
P: Oh, I don't know. I think it was it was a little bit.
D: Did it happen each time, or has it only been a couple of times?
P: I think maybe, two or three times but then there have also been times when I cough up this, this stuff that I cough up is a little bit pink in color. It's not exactly blood, but it's, it's, you know, pinkish.
D: OK, and are you producing sputum each time you're coughing up?
P: Most of the times, yes.
D: OK, is this a change from previously? Did you have a dry cough before?
P: A bit more of a dry cough before, but I mean, so sometimes it will be a dry cough sometimes, uh, it was more of a wet cough, but it was, it was usually just this white thing coming up. It wasn't like, there was never blood before.
D: OK, and you're coughing more often as well over this last month?
P: Oh yeah, Oh yeah,
D: OK. Have you been experiencing any, any headaches?
P: No.
D: OK, how about any eye pain or ear pain?
P: No, no, no.
D: How about any eye redness or, or discharge?
P: Nope.
D: Any runny nose or sore throat?
P: no.
D: OK, have you had any fevers or chills?
P: Uhm, I, I checked my fevers, I checked my temperature uh, couple days ago. It's just been this little bit, 30, I think it was 38.
D: OK, so, yeah, that would be a fever.
P: That was I think two weeks ago.
D: OK, do you feel hot now?
P: Not really, no.
D: OK. Have you had any night sweats?
P: Uh, no.
D: And have you had any weight loss over the last several months?
P: Oh, yeah.
D: How much weight?
P: About 20 pounds.
D: OK, and so how, How long was that weight loss over?
P: I'd say about about, uh, three, three-four months?
D: OK and sorry, what was your starting weight, roughly?
P: Yeah, yeah I was, uhm, 210 pounds.
D: OK, uhm, so yeah, about a 10% reduction in your weight over the last couple of months, it sounds like. OK, How is your appetite been?
P: Uh, it's OK.
D: Alright, and have you been having any chest pain?
P: No.
D: Any, any wheeze?
P: No.
D: Have you had any dizziness or lightheadedness?
P: Uhm no, no.
D: OK, how about any nausea or vomiting?
P: No.
D: Any diarrhea or constipation?
P: No.
D: Any urinary problems?
P: No.
D: Any skin rashes or muscle aches.
P: No.
D: OK, and, uh, have you been diagnosed with any medical conditions before?
P: Yeah, I've been diagnosed with COPD, with, uh, high blood pressure and high cholesterol.
D: I see, alright and do you take any medications for those?
P: Uh, I take Lipitor.
D: OK.
P And I take some puffers but don't use them very frequently. I forget to use them. And they, I tried them, but they haven't been very helpful these past two months.
D: OK, so yeah, you've tried them, when you were short of breath and they haven't helped?
P: They haven't done much.
D: OK. And are you allergic to any medications or have any allergies?
P: Uhm, no.
D: Alright, and have you been hospitalized for any reason, or like, including COPD exacerbation?
P: Oh yeah, yeah.
D: Or any similar symptoms?
P: It's been, uh, I was, uh, I was actually hospitalized about four or five times last year.
D: And was this for COPD exacerbations?
P: Yeah, yeah.
D: OK, did those each require a stay in the hospital?
P: Two or three of them I did, yeah.
D: OK. And have you had any surgeries?
P: Uh, no.
D: And are you currently smoking?
P: Yeah.
D: OK, how much do you smoke per day?
P: I've got it down quite a bit. I only have two cigarettes a day. I used to have a pack and a half, Uh, but I've got it down a lot. I'm trying to, I'm trying to quit, but it's hard.
D: Yeah, for sure it's great that you're working towards quitting. We can discuss that further and there are several options that might be available to help if it's something you're interested in, because yeah, it's definitely really hard. Are you, do you drink alcohol?
P: Uh, once in a while, on Christmas.
D: OK, and do you use any recreational drugs?
P: No.
D: You smoke marijuana or use marijuana products?
P: No.
D: Alright, and who are you living with currently?
P: I live with my wife.
D: OK, and are you, uhm, do you help looking after the home, and uh, like functionally independent right now?
P: Uh, yeah. I use a cane.
D: Mhm, ok.
P: And uh, yeah, my, my son comes over and helps out with groceries and my wife cooks but, I, I help her with cleaning sometimes.
D: OK, great and, so are you retired?
P: yep.
D: OK, uhm, and has anybody in the family had any heart or lung conditions?
P: My dad died of lung cancer. He was a, he was a big smoker as well. And my mom had a heart attack.
D: OK, and how old were your parents approximately?
P: Yeah, my dad was 65 and my mom was, was very young, she was 50.
D: I see. Did your mom survive the heart attack?
P: No, no she did not.
D: Oh, I'm sorry to hear that. Uhm, and the lung cancer you mention, any other cancers that run in the family?
P: No.
D: OK, so that was all the questions I wanted to ask on on history. Uhm certainly it sounds like you're bringing up some blood with, with, with the increased cough and with difficulties breathing so we will get a, uhm, a chest x-ray and possibly a CT image of your chest as well to see if there's anything going on in your lungs and we might do some blood work as well to check a few things so uhm, we'll get those ordered and, and see what, see what that shows.
P: Thank you. |
dataset\resampled_file\RES0077.wav | D: So what brings you here today?
P: Yeah, so I've had this cough, ongoing now for the last three days and I found I've had a more difficult time breathing as well.
D: OK, and So what came first? did the cough come first?
P: Yeah, the cough started first.
D: OK and so it started three days ago?
P: Yeah.
D: When did the shortness of breath start?
P: That started probably about two days ago.
D: OK, and the cough, can you describe it a little bit? Is it like a wet cough, a dry cough? How would you describe it?
P: Yeah, I brought up a little bit of sputum. It's been clear, mostly clear and sometimes dry as well. The cough's been getting worse over the last couple of days as well and hasn't really stopped either, it's just kind of ongoing all day.
D: OK, so it's it's pretty constant?
P: Yeah, it's been constant.
D: OK, and how much sputum would you say you're bringing up?
P: I would say, uh, maybe like two teaspoons a day. It's only like a little bit in the tissues and I'm not bringing up sputum every time.
D: OK, and is your sputum at all yellow, green? Or does it have any blood tinge content in it?
P: No, I haven't noticed anything like that.
D: OK, so it's mainly just white or clear.
P: Yeah, it's mostly, yeah, like whiteish or clear.
D: OK, uhm, and have you had anything like this happen before?
P: No, I haven't.
D: OK, and how would you describe the shortness of breath? Are you having trouble taking deep breaths or are you having trouble breathing when exerting yourself, like how would you describe it?
P: Yeah, I have like, a chest tightness. I find when I exert myself it gets worse and after I cough, I have a little bit of trouble catching my breath as well.
D: OK, When do you have the chest tightness, when did that start?
P: Uh, yeah, that's started within the last two days as well, with the cough.
D: OK, so is it just the tightness when you cough or is it there just throughout?
P: Yeah if I take like a deep breath in, like, it just feels tight, like I can't get a deep breath.
D: OK, and have you had any kind of, like swelling in your calves, or pain in your calves at all?
P: No, I haven't had anything like that.
D: OK, and have you had any surgeries recently or have you been immobilized for a long time or admitted to a hospital or anything like that?
P: No, I haven't had anything like that, I've been healthy.
D: OK, and have you had anything like a blood clot, either in your legs or traveling up to your lungs in the past before?
P: No, I haven't had anything like that.
D: OK, and have you been diagnosed with cancer or any other medical conditions?
P: No, I haven't.
D: OK uhm, so would you say the coughing and the shortness of breath is getting worse, or it's about the same?
P: I'd say it's gotten a little bit worse over these last couple of days.
D: OK, and is there anything that makes your symptoms better or worse?
P: Yeah, if I exert myself it does make it a bit worse. It'll bring on the cough more, and shortness of breath.
D: OK, and how about any positional changes? Like, does lying down help? Does resting help relieve some of that tightness, cough and shortness of breath?
P: No, nothing like that has helped.
D: OK, and have you tried any kind of medications at all, over the counter?
P: No, I haven't tried anything.
D: OK. Alright, so it seems that your shortness of breath, is it, uh, mainly when you're breathing in or breathing out? Or are you having shallow breaths? How would you describe it?
P: I would say it, yeah, I kind of go back to the chest tightness, it just feels like I'm not able to, like, breath in all the way and catch my breath after I exert myself or coughing. It's easy Uh, like if I rest I'm not short of breath.
D: OK, do you have any other symptoms? like a runny nose, sore throat? Anything like that?
P: Uhm, nothing like that.
D: OK, and any headaches?
P: I have had a little bit of a headache over the last day. Usually I get headaches like this when I haven't slept well.
D: OK, and is it like a different type of headache and is it on one side of your head or both?
P: Yeah, I feel it on both, kinda like right up into my forehead there.
D: OK, and is it kind of like a pressure like pain? Is it pulsating pain? How would you describe it?
P: I would say it's more of a pressure, yeah.
D: OK, uh, have you tried any medications for it?
P: Uhm, Yeah, I took an Advil this morning. It's taken the edge off a little bit. I will use that sometimes when I get headaches.
D: Are you having any nausea or vomiting?
P: No, I haven't had anything like that.
D: OK, and have you traveled outside of the country or outside of the province at all?
P: No, I haven't.
D: Have you been in contact with anyone that's been sick recently?
P: I don't think so. I work at the Toyota factory and there have been a few people that have been sick who worked there? But I don't think I've been in contact with them.
D: OK, and are you having any fevers or chills at all?
P: I have felt pretty hot, yeah, I was sweaty last night, I didn't check a temperature, but I felt feverish.
D: OK, were you having night sweats?
P: My bed wasn't drenched or anything but I was sweating.
D: OK are you feeling like you have lost any sense of taste or smell at all?
P: Uhm, Yeah, I haven't been able to smell very well.
D: OK, and when did that start?
P: That may be within the last two days as well.
D: OK, and are you congested at all? Like, do you have a runny nose or anything like that?
P: No, I don't have anything like that.
D: OK, yeah, any changes in your bowel movements, like any Constipation or diarrhea?
P: No, I haven't had anything like that.
D: OK, any muscle aches?
P: Yeah, I have felt a bit sore.
D: Where would you say you feel sore?
P: Just kind of all over, my whole body just kind of feels a bit achy.
D: OK, and when did this start?
P: Yeah, probably like last night, this morning when I was laying down and just felt a bit tired and achy?
D: OK. Has your sleep or appetite changed at all?
P: I didn't sleep very good last night. I just don't feel very rested this morning. And yeah, I haven't felt very hungry either.
D: OK, uhm, alright, do you have any medical conditions that you take any medications for?
P: No, I don't take any medications.
D: OK, and have you had any surgeries or have been hospitalized before?
P: I did have tubes in my ears when I was little, but that's it though.
D: OK. Any family history of any heart or lung conditions?
P: Yeah, my dad had a triple bypass surgery done last last year. He was sixty-three at the time and that's about it.
D: OK, and you don't have any high blood pressure or anything like that, right?
P: No, not that I know of.
D: OK, and do you have any allergies?
P: Uhm, just environmental stuff I think, just, like in the springtime, I'll get itchy eyes or a runny nose.
D: OK, and currently do you work?
P: I do, yeah I work at a car factory nearby, just on the assembly line.
D: And have you been off of work right now, with your symptoms? How is that going?
P: Oh yeah, just like these last two days I called in and I let them know and I left work early yesterday when I realized that I was feeling sick and didn't go in this morning.
D: OK, uh, and what's your living situation like?
P: So I live with my girlfriend, and we have a son who's four years old.
D: OK, and any one of them having any similar symptoms?
P: No, they've been good. My wife works from home and my son, he's been his playful self.
D: OK, that's good. OK, last few questions. Do you smoke at all?
P: No, I don't.
D: Do you use any recreational drugs like marijuana?
P: Uh, no, I don't.
D: OK, and do you drink alcohol?
P: I'll have some wine with dinner, maybe two or three nights a week.
D: OK. Yeah, those are all the questions I had today and it seems that definitely there are some concerning symptoms like the shortness of breath and the cough especially also the loss of smell that you're having. We definitely want to make sure that you don't have coronavirus, so we will do a test for you today. And what we recommend in the meantime is to self isolate, even in your home, wear a mask around your family, if you can, like, eat separately, don't go outside and be off of work until the test results come back and then even after that, you might need to follow instructions of public health and self isolate for 14 days. If not coronavirus, hopefully, then it can also be other things, like, other viruses can cause similar symptoms as well, but yeah. So, we'll just get that test done and then see where to go from there.
P: OK, that sounds great. Thank you.
D: You welcome. Take care, bye. |
dataset\resampled_file\RES0062.wav | D: What brings you in?
P: Well, I've had this cough but the biggest issue is that I've been really short of breath.
D: OK, um, when did the cough start?
P: I would say about 3 days ago.
D: Three days ago, OK, and uh, around that time did you also start feeling short of breath?
P: Uh, the shortness of breath has come on, I don't know within the last day or so. It's come on after that, the cough started first.
D: OK, and the cough, is it a dry cough or is it a wet cough?
P: Well, I've been bringing up some yellowish green, kind of like phlegm, so um I guess a wet cough.
D: OK, so yeah, yellowish green you said.
P: Yeah.
D: OK, any blood in the sputum?
P: I haven't noticed any blood.
D: OK, and how much sputum are you coughing up each time? Like is it kind of the size of your fingertip or does it fill your whole palm?
P: Um, yeah, probably more like the size of like a thumb tip.
D: OK, OK um, and do you notice any, like pus or froth in the sputum?
P: Nothing like that I noticed.
D: OK, and if you were to describe the sound of your cough, does it sound like it's barky or like a hacking cough?
P: I don't know, I guess hacking.
D: Alright, and do you hear any wheezing at all?
P: No, well, maybe I guess when I'm really short of breath, yeah, wheezing, yeah.
D: OK, and the shortness of breath, how severe is it? 1 to 10, 10 being the worst?
P: Maybe a 7?
D: At seven OK, are you having issues sleeping because of your shortness of breath?
P: Uh, well I can't tell if it's that or the cough. I mean between those two things it's been definitely interrupting my sleep.
D: OK, and do you find there are any triggers to your coughing like like um, a particular time of the day? Triggers like you know pollen or things in your environment like pets?
P: No the cough has been kind of going on all day. Um, right when I get up in the morning and goes on all night, it's been getting worse to these last few days.
D: OK yeah, um yeah, that doesn't sound great in terms of your shortness of breath. Do you find that certain positions make it worse? Or like exerting yourself makes it worse?
P: Um, not really.
D: OK, and have you ever experienced anything like this in the past?
P: No, I haven't.
D: OK. And any other symptoms that you have along with your coughing and sputum?
P: As soon as I breath, well, I just haven't felt good like, tired, kind of weakish.
D: OK yeah um, along with your fatigue and feeling weak, have you experienced any dizziness or fainting spells?
P: No dizziness and I haven't fainted or anything like that.
D: OK, any confusion or memory loss?
P: No concerns with my memory.
D: OK. And how about um, muscle aches or any sort of body aches?
P: Alright, yeah, maybe a bit, kind of, and weak.
D: Yeah, alright, so let's go back to your shortness of breath. Do you have any chest pain associated with that?
P: Uh, no.
D: OK, and do you ever feel like your heart's racing?
P: No, nothing like that.
D: OK, and how about changes to your bowel movements?
P: No, those have been normal. I haven't had any diarrhea or constipation.
D: OK and no blood in your stool?
P: I haven't noticed any blood, no.
D: OK, how about abdominal pains?
P: Oh yeah, I don't know why, yeah, my belly's been a bit achy maybe.
D: OK, and how about a sore throat?
P: No, my throat felt OK.
D: OK, good and have you experienced any loss of taste?
P: No loss of taste, but I've noticed, yeah, my smell has been kind of funny.
D: Your smell has been kind of funny, like you can't smell or do things smell differently than you expect them to?
P: Yeah, there was a candle on earlier today and I guess I couldn't really smell it, so I guess I haven't been able to smell.
D: Ok, do you have a runny nose or a blocked nose?
P: No, I haven't had to blow my nose or anything.
D: OK, any changes in your vision or hearing?
P: No, that's been normal.
D: OK, any discharge or pain in your eyes or ears?
P: No, that's been OK.
D: OK, and then any changes to your urine?
P: No, I haven't had any pain or anything like that.
D: OK, and are you otherwise healthy? Do you have any medical conditions?
P: Yeah, I have atrial fibrillation. And I do take Metoprolol for that.
D: OK, how long have you had A. fib?
P: It was like 4 years ago I think it was. It was having that like, felt like my heart was racing you were asking about earlier and they did an ECG and I was told I had atrial fibrillation. So yeah, I've been on a beta blocker for three years now.
D: OK, four years, and when was the last time you had an ECG?
P: Uh, maybe just a couple of months ago. I think every time that I come in to see my family doctor, they they do one.
D: OK, and the last time that it was done, was it normal?
P:Yeah, they said yeah. My heart rate's been around 80 beats per minute which is good and I haven't had any symptoms so things have been stable.
D: OK, good. And then have you had any hospitalizations or surgeries in the past?
P: I had an inguinal hernia repair about 15 years ago.
D: OK, any complications from that?
P: Um no.
D: OK, and then besides the Metoprolol, are you on any other medications?
P: Oh yeah, I take a statin and baby aspirin.
D: OK, and is that for the A. fib as well, the aspirin? Or is that just for other cardiovascular issues or some sort of preventative measure?
P: Yeah, I heard it was good for people who have atrial fibrillation so I started taking it.
D: OK. and let's revisit your medications at the end of today's session. I just want to make sure that you're on the medications and I just want to make sure you're on the right dose. Does that sound good?
P: Yeah, certainly.
D:OK great. And ok, so we talked about your past medical history and medications. We will talk a little bit about any allergies that you have, if you have any.
P: I think it's like a sulfa allergy. I received an antibiotic like that many years ago and had a rash.
D: OK, OK and have you had any reason to suspect that you may have taken any sulfas recently?
P: No, I haven't had any antibiotics so no, really no changes.
D: OK, OK, good and are you up to date with all your immunizations?
P: I am yeah. I've received the Zoster vaccine for shingles and also the one for pneumonia.
D: OK, good, good yeah, those two we definitely recommend if you're over 65. OK, and do you know of any family history of lung conditions or heart conditions?
P: No, I think my aunt had lung cancer but she smoked her entire life.
D: OK, OK and how about other cancers?
P: No other cancers.
D: And have you been in touch or do you think you've been in contact with any anyone sick recently?
P: Well, I visited my mother at a long term care facility just this past weekend, so I guess about just over a week ago I visited there.
D: OK, and have there been any COVID outbreaks at the long term care?
P: Yeah, there has been, I thought I was like away from those areas but I have heard about outbreaks there.
D: OK, OK and any travel history?
P: No travel.
D: And do you smoke?
P: I used to smoke a pack of cigarettes a day, but I quit about, uh, about five years ago. I know four years ago it was when I found out I had atrial fibrillation. I quit.
D: OK, OK, well that's good. Good for you for quitting. How about marijuana?
P: No, I don't smoke it, but I'll use some edibles I buy from the Ontario stores a couple of times per week. Just the CBD stuff.
D: The CBD stuff OK. And how many milligrams?
P: I'm not sure, I know it's their lowest dose though.
D: OK, OK if it's lowest dose, it might be 2.5 milligrams.
P: Sounds familiar.
D: OK good. Is there a particular reason you take these CBD edibles?
P: It helps me sleep.
D: OK, if it's specifically to help you sleep, we can actually try and see if there are other options for you. You know there are pills, like they are sleep aids. Or even things like melatonin that can help regulate your sleep so we can revisit other options for you if you're open to that as well.
P: OK for sure. Yeah I will. Um, yeah we can talk about that later.
D: OK, that sounds good and do you do any other recreational drugs?
P: I do not.
D: OK, how about alcohol?
P: Uh, no, I don't drink anymore.
D: OK, and did you used to drink before?
P: Yes, I just stopped a few years ago,
D: OK, and what's your living situation like right now?
P: I live in a house with my wife.
D: In a house, OK. Any concerns for like old carpets, mold or asbestos in your house?
P: No, we've renovated it over the years.
D: OK, good and I apologize, but I would like to clarify three more symptoms with you. Did you say you felt like you had a fever earlier?
P: Um, maybe I've been feeling a little hot, but it's been really more the cough and shortness of breath that's been bugging me.
D: OK, well we can take a temperature today just to make sure. Have you been feeling like you have night sweats or chills?
P: Um, not really. No, I haven't noticed that.
D: OK, and how about, um, any weight loss over the past few months?
P: No, it's been been stable.
D: OK, alright good, so that brings us to the end. Do you have any questions or concerns that you would like to clarify before we end the interview?
P: No, nothing today. I was just really hoping to get, uh, whatever this is sorted out.
D: Yeah, you know, um, right now it looks like, it sounds like it could be an upper respiratory viral illness, so that includes COVID. So we will do a swab for you and then send it off to the lab for PCR results. In the meantime, because you have symptoms that overlap with COVID symptoms, we do encourage isolation for 14 days. Until your symptoms are gone, sorry, until your symptoms are gone, even if they're gone, we do suggest isolating for 14 days just to make sure you're not a carrier or could spread COVID so we do encourage that, and that includes from your husband. If possible, we will get those results in a day or two. If they are positive, we will send your results to public health who will be in touch with you to do some contact tracing to see where you may have gotten it from. If it's not COVID, it could be other viral illnesses that are going around this time of year. And if your symptoms aren't getting better on their own, and there's reason to suspect you may have a bacterial infection or bacterial pneumonia, we will follow up with you and possibly prescribe antibiotics. How does that sound?
P: Yeah, that sounds like a great plan.
D: OK, great so um, I will see you at the next appointment.
P: Thank you. |
dataset\resampled_file\RES0192.wav | D: How may I help you?
P: Hi, I'm I'm coming in because um I've had a lot of shortness of breath and I I've had this cough that won't seem to go away.
D: I see alright, so when does the shortness of breath happen it? Do you have it at rest or is it on exertion?
P: Mostly on exertion.
D: OK, how far are you able to walk before you get shorter breath? Or how many flights of stairs are you able to do?
P: Uh maybe like 2 flights of stairs?
D: OK. And when did you notice that the change?
P: So I've had this shortness of breath like at first it was pretty mild. It started about, four months ago, but over the past month or so, it's been it's been worse.
D: OK, so a bit so it's been going on for a bit of time now.
P: Yeah,
D: OK um. Do you, are you able to lie down flat without experiencing shorter breath?
P: Yeah, I think so. I think that's fine.
D: OK, um so so it sounds like no orthop is what they call it, and have you had any episodes where you wake up in the middle of the night and you're short of breath and you need to sit up an end to catch it?
P: Uh no.
D: OK, and have you had any leg swelling?
P: No.
D: OK. Any, you mentioned that you've had a cough as well. How long have you experienced a cough for?
P: Uh, the cough also around the same time it started off pretty mild, but now I like I have it all the time.
D: OK, are you coughing up any sputum or any phlegm?
P: Uh no it's it's pretty dry.
D: Are you coughing up any blood?
P: No.
D: OK. And have you had any um wheezing?
P: No wheezing.
D: OK. How how about any chest pain?
P: Uh no chest pain, I guess with the coughing 'cause I'm coughing so much it hurts but not chest pain in the sense like it's in the area of my heart or anything like that.
D: OK, so does that. Like how would you describe it? Is it like sharp, achy, uh dull or pressure like?
P: Um it's a. It's kind of like a tugging feeling.
D: OK, um it does it go away after you're done coughing,
P: Yeah.
D: I see OK. And have you experienced any um any headaches?
P: No, no headaches.
D: OK, how about any um? Like eye redness or eye discharge?
P: No.
D: any ear pain or your discharge?
P: No.
D: How about any changes to vision or hearing?
P: No.
D: OK. Have you had a runny nose or sore throat?
P: No.
D: OK, how about um any changes to or have you had any loss of smell or any loss of taste?
P: No.
D: OK. And have you had a loss of appetite?
P: No.
D: OK, and have you had any unexpected weight loss over the last several months?
P: Um I have had some weight loss actually. About 15 pounds over the past six months.
D: OK, and have you been trying to lose weight?
P: No.
D: OK. Um have you had any fevers?
P: No.
D: Have you had any chills?
P: No.
D: Have you had any night sweats?
P: No.
D: OK. Um and have you had any heart palpitations or feeling like your heart's racing?
P: No.
D: Have you had any fainting or lightheadedness or dizziness?
P: Um no.
D: OK. Um have you had any abdominal pain?
P: No.
D: Have you had any nausea or vomiting?
P: Uh no.
D: have you had any diarrhea or constipation.
P: No.
D: And, have you had any skin rashes?
P: No.
D: Have you had any muscle aches or joint pains?
P: No.
D: And have you had any ah confusion or memory loss?
P: Uh No.
D: OK, OK, and how is your energy been uh recently have you had any fatigue or malaise?
P: Um no.
D: OK, alright so it sounds like this this dry cough and then and shortness of breath it is mostly what you been um experiencing and have you been diagnosed with any medical conditions?
P: Ah I have uhm a COPD.
D: OK, um and do you use uh any medications or any inhalers?
P: Um know it's very mild. I it’s yeah, so I haven't really. I was just recently diagnosed so uhm I haven't been started on any medications just yet.
D: OK, did you, do I I pulmonary function tests where you're breathing into a tube,
P: yeah
D: Alright. Yeah, and uhm do you have any allergies?
P: No.
D: Um and have you had any hospitalizations or any previous surgeries?
P: No.
D: OK and could you tell me a little bit about your living situation? Like where you're living and who you're living with?
P: I live in a house with my husband.
D: OK, and has your husband been sick or anybody you've been around been sick?
P: No.
D: OK. And are you currently working?
P: Yeah, so I. I'm working in construction. Um I used to work in shipyards before, but recently I've I've been doing some construction, nothing heavy, ah just working on some old buildings. I’ll ust take the odd job or something that comes up. It's not full time.
D: OK. And any concerns for like exposures while you're at work in terms like breathing in any dusts or any fumes.
P: Um were given a um personal protective equipment um for those concerns, but when I was younger I used to work a in shipyards and constructions and like old buildings and stuff, and I know there was some concern for not being ah properly equipped with the right equipment for protection and safety at that point so. Uh yeah, it's possible. I've been exposed to some things.
D: I see is there a chance that there could have been asbestos at any of those places that you worked?
P: Yeah, asbestos or mold. Yeah, you name it. Probably everything.
D: Yeah, I see this was like 10 years ago 20 years ago or or longer?
P: Yeah, and so it would have been. Yeah, about like 30 years ago or yeah 30, 40 years ago and. I worked in those places for 30 to 40 years, so. Around that time.
D: OK, and do you smoke cigarettes?
P: Um I quit recently since I found out that I might have COPD.
D: Oh congratulations, it's not easy to quit.
P: Thank you.
D: Uh and do you drink alcohol?
P: Uh once in a while? I’ll have a glass of wine once a week.
D: OK, and do you use recreational drugs?
P: Um no I don't.
D: OK. Um and uh are there any heart or lung conditions that run in the family?
P: Uh no.
D: OK, are there any cancers that are in the family? Like anybody who's had lung cancer?
P: Um. No, not that I can think of.
D: OK. And um have you traveled anywhere recently?
P: No.
D: OK, and are you currently sexually active?
P: I am.
D: OK um and can you tell me about your partner or partners? Is it's at your husband or um anyone else?
P: Just my husband yeah.
D: OK and any concerns for ah sexually transmitted infection?
P: No.
D: OK. And I think that was everything that I wanted to ask on history today. Um was there anything else that you wanted to add that I maybe forgot about?
P: Um no that was it, but how like what can I take to make these symptoms go away?
D: Well yeah, so at this time It will be important to get some lung imaging and and possibly, some other investigations as well because of your exposure uh to inhalants and fumes, and possibly asbestos. So I’m concerned there could be possibly an asbestos related lung illness that that you have. Um and so it will be important to investigate for, yeah possibly a asbestos related lung cancer,
P: OK?
D: Yeah.
P: OK, thank you. |
dataset\resampled_file\RES0137.wav | D: So what uh, brings you here today?
P: I am here with uh, with my daughter, who has just been having a cough for the past um, two weeks.
D: Okay, um, and can you describe the cough a little bit? Is it a dry cough or is she bringing anything up?
P: Um, it is a, it is a dry cough, um, but she just keeps coughing and coughing and, and then she just, you know, once she'll start coughing she just doesn't stop. And then um, there's been times when she just turns blue, she's coughing so much. Um, and then it just gets, gets better um, on its own. But yeah, it's a dry cough.
D: Okay, and um, what does the cough sound like? Is it like a harsh cough, a barky cough?
P: Um, it's just, she just makes this noise when she's like breathe, trying to take a breath in. It's, it's yeah.
D: Okay, is it kind of a wheeze?
P: Yeah, sure.
D: Okay. Um, and so there's episodes where she also turns blue?
P: When she's coughing a lot, yeah, she does.
D: Okay.
P: She's also vomited once or twice.
D: Oh, I see, okay. Um, any blood in the vomit? Or is she coughing up any blood?
P: No.
D: No, okay. Um, any, so this started two weeks ago, any kind of symptoms of runny nose or um, cold-like symptoms before then?
P: Yeah, yeah she did have a bit of a runny nose. It was just uh, watery, uh, since discharge. And at that time her cough, she had a cough as well. Um, but I thought it was, you know, it's nothing. It was just like another flu and it would get better, but then she just, the runny nose got better without, in a couple of days, but the cough stayed. And it got, got pretty worse, uh, it got worse.
D: Okay, um, other than the cough uh, any, any fevers or chills?
P: No, I don't think she's had fevers. I haven't checked, though.
D: Okay. And the cough is pretty constant, or is it, does it come and go?
P: Yeah, she just has these episodes where she just coughs and coughs and coughs, and then she'll either vomit or just turn blue, or just um, get better in a couple, couple minutes. This kind of comes and goes like that.
D: Okay. And is there anything that has helped her at all? Like any over the counter medications or anything like that?
P: I haven't tried anything, I'm just worried about, you know she's my first child and I don't know what to give her and what not to give her at this age. So I just decided to come in and not try anything over the counter.
D: Okay. Um, and so, has this happened before at all?
P: No.
D: No, this is the first time, okay. Um, any so, she, she is vomiting. Um, is the vomit like green in colour? Or is she just vomiting up what she has eaten? What's the content of the moment?
P: It's usually just what she's eaten.
D: Okay, um, any sick contacts recently or any travel?
P: No, I don't think so. Not, nothing really.
D: Um, and how about her behaviour? Does she seem like uh, very tired or fatigued, or more irritable?
P: She does get tired, especially after, and then she's irritable and crying after, you know, she has these fits of coughs.
D: Okay.
P: Yeah.
D: Okay. Um, any symptoms of diarrhea or constipation?
P: No.
D: Okay. Any um, any trouble with urinating at all?
P: No.
D: No. How's her sleeping like?
P: Uh, not great. It's just the cough keeps uh, waking her up and she just doesn't, can't fall asleep.
D: Okay, any uh, exposure to dust or fumes, or animals or pets at home?
P: We, we did get a cat um, about a month ago.
D: Okay. Um, and any, has she been diagnosed with any medical conditions in the past?
P: No.
D: Um, and any allergies that you know of?
P: Um, no.
D: And um, any previous hospitalizations or surgeries?
P: No.
D: And how was your pregnancy, your pregnancy with her, like any complications at all?
P: No, no complications. It was uh, it was very, yeah, it went well.
D: And was she at term or premature?
P: She was at term, she was born at term.
D: Was it a vaginal delivery or uh, a c-section?
P: Uh, vaginal.
D: And did she have to stay in the NICU at all, at the hospital afterwards?
P: No.
D: Okay. And is she feeding well, like what does she usually eat?
P: She's feeding well. She's doing uh, she eats everything, yeah.
D: Um, and any family history of any medical conditions?
P: No.
D: Um, and does anyone smoke in the house?
P: Um, her dad, but he, he doesn't smoke in front of her.
D: And what's her living situation like? Who does she live with? And do you live in a house, apartment?
P: Oh yeah, we live in an apartment. It's uh, me, my partner, her and the cat.
D: Okay. And any difficulties or complications with her growth? Like in terms of her weight or her height?
P: No, no complications. She's doing okay.
D: Okay. And in terms of her milestones, has she been meeting all of them on time?
P: Yes.
D: Okay. Alright, so I think those are all the questions I have for you today. Do you have any questions or concerns?
P: Uh, no.
D: Yeah, so based on the symptoms, oh yeah, sorry I forgot to ask one other question. Has she, are her immunizations all up to date?
P: Oh no, no. I don't, I don't get those. My friend's, my friend's daughter developed autism and I'm just, I don't want that, you know, so no. I don't vaccinate my kids. Or I don't vaccinate my daughter and I haven't been. Yeah, uh no, I won't be doing that.
D: And have you been vaccinated throughout your life?
P: Um, maybe when I was young, but I, yeah I don't, I just don't believe in vaccinations. I, yeah, no, I don't, I don't get those.
D: Yeah, so there is definitely uh, there's a lot of research done beside, behind vaccinations and a lot of prevention goes into them, but definitely there is some anecdotal evidence of very loose associations to autism that have been found to be invalid and like they have been invalidated by the research. So definitely, it's very important to get your child vaccinated. In fact, the sum of the symptoms that your child may be having right now can be caused by something called pertussis, and um, there's usually a vaccination for that. Like after pregnancy as well, so that's something that is definitely on the differential, and at this time we definitely need to make sure she's okay and get her vitals done, see her oxygenation saturation, and just do supportive care while she's in the hospital, and we may need to admit her, but we'll do the full physical examination today, get a COVID swab done as well. And usually it, she's currently in the, it seems to be the second phase, where she's vomiting and coughing a lot, and then it usually, after that phase, two or three more weeks of just coughing. And so, we're going to do some supportive care for her right now, but yeah, definitely, you should consider vaccinating your child. We recommend that to every parent as there's a lot of diseases out there that can be completely prevented if you vaccinate your child.
P: Okay, I'll think about it.
D: Alright, so, so for now we're gonna just make sure that she's doing well, okay?
P: Sure.
D: Alright, take care. |
dataset\resampled_file\RES0097.wav | D: How can I help you today?
P: Hi, I'm, I'm the mom of the patient and I just wanted to talk to you about the, just about Thomas here. He's just been not, he's just not been feeling well. He's had this cough for the past three or four days. And he's also had this stuffy nose, and this, this watery discharge. Yeah, he's just not feeling good.
D: OK, I see and so the, the cough you said started three or four days ago. Has the cough gotten any better or any, stayed the same or gotten worse?
P: Gotten a bit worse, I would say.
D: Is he bringing up any sputum?
P: No.
D: So has there been any blood?
P: No no.
D: OK, and has the cough interfered with sleep?
P: Yeah, his cough is usually worse, uhm, at night.
D: OK. And you say that he's also had a runny nose. What does the discharge look like?
P: It's just, uh, it's watery.
D: And this started three or four days ago as well?
P: A little, a little after the, uhm, yeah actually, around the same time, around the same time, yeah.
D: OK. Has he had any, uhm, like difficulties breathing, like saying that he feels one of the, like the nostrils obstructed?
P: Hmmm, he hasn't, well, he's just been breathing with his mouth open, so that's what he does at night as well. He also has this nasal voice right now, probably because it's, it's, you know, he has this stuffy nose. But he hasn't really complained about it.
D: Yeah, has he had any pain, like facial pain?
P: Uhm, no, not really.
D: OK, how about any changes to smell or loss of smell?
P: Yeah, I don't think he can smell much right now.
D: OK, and uh, did those, did that start a few days ago as well?
P: Yeah, yeah, since he's been complaining of his stuffy nose.
D: OK, and has he had any headaches?
P: No, but he has had a fever.
D: OK. How, did you check it?
P: Yeah, I did, I did. It was uh, 39 last night.
D: Alright, it's certainly a fever. Uhm, has he had any chills or night sweats?
P: Yeah, he's, but he's been feeling pretty chilly.
D: OK.
P: Yeah, he's wearing a couple, a couple of layers at home, still feels chilly, and yeah, he has alot of chills and definitely has a fever.
D: Alright, and has the fever been there the whole whole time, if you're aware or has that kind of come and gone?
P: Uhm, you know what, I actually just checked yesterday so I don't know.
D: Alright, has he had a sore throat?
P: Yeah, it's usually worse in the morning. I think it's more of a, I guess the post nasal drip you know with the, with a runny nose. It's just, It's pretty bad in the morning.
D: OK, has he had any red eyes or, or eye discharge or eye pain?
P: No no no.
D: OK, and has he had any shortness of breath?
P: No.
D: How about any wheezing?
P: No.
D: Any chest pain?
P: No.
D: Any lightheadedness, dizziness or fainting?
P: No.
D: OK, and does he mention anything about feeling as though his heart's racing?
P: No.
D: OK and has he had any abdominal pain?
P: No.
D: Any nausea or vomiting?
P: No.
D: Any diarrhea or Constipation?
P: No.
D: How about any urinary problems like pain or, or frequency?
P: No, nothing like that. He hasn't complained of anything like that.
D: Has he had any skin changes or rashes?
P: No.
D: And how about any muscle aches or joint pains?
P: Yeah, yeah he definitely has that. He's complaining a lot about muscle aches.
D: OK, and how has his energy been? Has he been fatigued?
P: Oh yeah. He hasn't gone out to play. He hasn't done anything, he's just been lying in bed.
D: OK, and over the last several months has he had any weight loss?
P: No. He's been gaining weight actually.
D: OK, no that's good. Certainly yeah, at the age of 11 should be still gaining weight, so that's good. And has he been diagnosed with any medical conditions in the past?
P: Yeah, he was diagnosed with uh, cystic fibrosis when he was a, he was a child, four years old.
D: OK, and, uh, is he on, uh, like any medications for that?
P: He's on, he was on an antibiotic until the age of five. Uh, that he had to take on regular basis, but he is, he's not really on any medications right now. I know that there are a couple of new ones that are out there, but those are very expensive.
D: OK, and has he had any exacerbations or hospitalizations?
P: uh, yeah, he's he's had about, uh, one hospitalization every two years?
D: Alright, and is he followed by a respirologist, currently?
P: Yes, yes, yes.
D: OK, uhm and has there been, like an increase in the sputum production or like worsening shortness of breath over these last few days?
P: No, not really.
D: OK. And has he had any surgeries?
P: No.
D: Does he have any allergies to medications?
P: Uhm, Sulfa drugs.
D: And the reaction is?
P: Uhm, he just gets a rash.
D: OK is it, are immunizations up to date?
P: Oh yeah, yeah, we're very careful about that given his diagnosis. He's got all the, all the vaccines.
D: That's great, that's really important for sure, uhm, and so I just wanted to ask about life at home a little bit. So who's in the house and who's the primary caregiver for him?
P: I'm the primary caregiver, its just, uh, me, him and my husband.
D: OK, and uh, is he, uh, what grade is he in right now?
P: He's in grade six?
D: OK, how is school going?
P: Schools going well, it's just the, yeah, the hospitalizations can sometimes be disruptive, but it's going well. He's, he's getting B's in his class. He's doing well, he's got a good group of friends.
D: Excellent and have you had any concerns about about development or, or his growth?
P: Uhm, no.
D: OK, so meeting all milestones and?
P: Yeah.
D: OK. And in regards to, uhm, birth history, were there any complications throughout pregnancy or, or at birth?
P: Uhm, no, nothing at birth or during pregnancy, but he did start having lots of respiratory infections, which is when the pediatrician did that test. I forget the name, for the test and then they were, uhm, the, uhm, he was found to have, CF.
D: OK, uhm, and does anybody in the home smoke?
P: No.
D: Or drink alcohol?
P: no.
D: OK, uhm, and are there any pets in the home?
P: No.
D: OK, has he been around anybody who's been sick?
P: I don't, I don't think so.
D: OK, and, uh, have you guys traveled anywhere?
P: No, just been at home.
D: OK, uhm, and has anybody in the, else in the family have cystic fibrosis?
P: No, no, no, no one else does. But we got tested and we were both found, my, my husband and I were found out have the gene for it. We were carriers.
D: OK, uhm, I see. And any, any heart conditions or, or other lung conditions that run in the family?
P: No, nothing else.
D: OK. And were there any other symptoms that, or anything else that you wanted to tell me that maybe I forgot to ask about?
P: Uhm, no, I was just, uh, I'm just worried about him, uhm about his fever specifically, it's been high and I know that usually when he has these hospitalizations, he presents pretty similarly. So just wondering if he would need to be hospitalized again and if he needs antibiotics.
D: Yeah, for sure it's, it's been uhm, so it's been three or four days, but with a fever this high and his symptoms, with uh, having obstruction, discharge, uhm, changes to smell or loss of smell it does sound like it could be bacterial and so I think it would be reasonable to possibly to start antibiotics in this case, but we'll go through, through a physical exam, check some vitals and go from there.
P: Ok, Ok, sounds good, thank you. |
dataset\resampled_file\RES0003.wav | D: It's nice to meet you. What's your name?
P: It's nice to meet you as well. My name is Jenn and I'm here with my son Joey here, who he's had a sore throat now for the last couple of days.
D: OK, how old is he, Joey?
P: Uh, he is 3 years old.
D: He's three years old, OK. And you said for the past couple days, so about 2-3 days?
P: Yeah, probably yeah about 3 days ago he he didn't go to school for the last two days because, or I mean daycare I should say because the pains but was bugging him so bad.
D: OK, yeah um. So how long has he been going to daycare for?
P: He started this year, so, um, he's been going for about six months.
D: OK? Is he having issues swallowing food? Does it hurt when he swallows food?
P: Yeah, he's, uh, he's definitely the last couple of days hasn't been eating as much like solid food. He's drinking cold liquids okay but yeah, he hasn't been eating as much.
D: OK.
P: He says it's hard to. He does say it hurts to swallow as well.
D: OK, and does does he ever clutch to his neck like his neck hurts?
P: No, he hasn't said anything like that. I mean nothing about his neck.
D: OK, um, have you taken his temperature at all?
P: Yeah we did and it's uh, it's pretty high actually, it was like 39.4.
D: OK wow, yeah that's pretty high. Have you noticed any swollen areas on his neck?
P: No, not I haven't noticed anything on his neck.
D: OK, any rashes that you've noticed?
P: No rashes.
D: No, OK. And has he been having chills or night sweats?
P: Um, nothing like that that we've noticed, no shaking or or sweaty bed.
D: OK, and how about like a stuffy nose or runny nose?
P: Uh, no, nothing like that.
D: OK, and coughing?
P: No cough.
D: No, and how about is he complaining of any body aches?
P: No, it's mostly just been is his throat his throat that he's complaining about.
D: OK, how about headaches?
P: Uh, He hasn't mentioned anything with his head.
D: OK, and has he been around anyone who's been sick? Maybe at his daycare?
P: I, I mean, his sister has had had some colds. She's also in his daycare. So I mean, maybe her.
D: OK, how old is she?
P: Um she's 2.
D: She's two. OK, so she's younger.
P: Yeah.
D: OK, any nausea or vomiting?
P: Ah no vomiting.
D: OK, how about um, diarrhea, constipation?
P: Haven't noticed anything like that, his his bowel movements have been normal.
D: How about urinating, has that been normal?
P: His usual amount is as, as far as I know.
D: OK. And OK, any issues with his eyes? Any like pus or bleeding or redness?
P: No, his eyes of have looked normal to me.
D: OK, how about his ears?
P: Those have also been normal.
D: OK, any sores on his mouth or inside?
P: Um no, it does kinda look like there. It's pretty red in the back of his throat when I was able to look, but yeah.
D: OK, and has he ever experienced any of these symptoms before?
P: Um, he's had sore throats before, but I think this one is a bit more severe. He hasn't complained this bad before.
D: OK, OK. Um has he tried anything for it? Have you given him any over the counter medications?
P: Yeah, we we did use some Tylenol and it brought the fever down so that was part of the reason why we we didn't come in 'cause he's had sore throats before but the fever bounced back and and the pain seems to have continued so we came in.
D: Ok, OK. And is he otherwise healthy? Does he have any medical conditions?
P: Uh, yeah, he's otherwise healthy no medical conditions, um hasn't been, had a reason to see a doctor before.
D: No, OK. And then just how was pregnancy with him? Was it normal? Any complications?
P: Um yeah there, so had um gestational diabetes, but it was treated, it was treated with diet. Um and blood sugars have been fine now, but no complications to the pregnancy from that regard as far as I know.
D: OK, any alcohol or recreational drugs used during the pregnancy?
P: No, nothing like that. No. No smoking either.
D: OK, OK, good um and how far along were you when when you delivered him?
P: Um it was a vaginal delivery just after 38 weeks. OK so he was full term.
D: And you said vaginal delivery? Did they have to induce you at all?
P: Um no no.
D: OK and was he a normal birth weight?
P: Yeah he was. Yeah, I think he was like just over 3 kilograms.
D: OK, good and was he healthy after birth? Did he have any breathing issues? Jaundice? Anything like that?
P: Um, no breathing issues or or jaundice. He came home with us right away.
D: OK, OK and then after that point to now has he been normal in terms of his weight, height, head circumference?
P: Yeah yeah. He's been growing normally and eating well up up to this point.
D: OK, and I should ask um has he been hitting all his milestones like, is he doing the things that his peers are doing?
P: Yeah, I would say he's keeping up with his his peers in daycare and no concerns with his development.
D: OK, good. Is he on any medications?
P: No medications.
D: No. OK, and is he up to date with all his immunizations?
P: He is yes.
D: OK, and any allergies?
P: Not that we're aware of.
D: OK, any family history of lung conditions?
P: Um no, no family history of any lung conditions.
D: OK. And So who does, who does he live with at home?
P: So he lives with my myself, and his father and then sister. So there's just the four of us at home.
D: OK, and what's the relationship like between all of you? Any domestic issues? Or are things OK?
P: Oh, things are are great at home. It's a really supportive environment.
D: OK, good and does anyone smoke at home?
P: No one smokes at home.
D: No, OK. Um, any carpets at home? Old carpets?
P: I think there's there's a few area rugs around, but most of the carpets are gone.
D: OK, OK Um alright, so it sounds like, um grom what you're telling me, he ohh sorry, I should have asked you this earlier. Has he had any issues breathing?
P: Um no problems breathing, but his voice does sound a bit, a little bit off. A bit Husky.
D: A bit Husky, OK. Um alright and nothing like a seizure like a febrile seizure, right?
P: No, I haven't seen any like limb jerking or anything like that.
D: OK, so um, just roughly doing from the sounds of it, it sounds like he has a sore throat that's been persistent and we do this thing called the Centor score. So it sounds like he's had a fever, no cough, a sore throat. So the first thing that we want to check to see or to rule out would be a strep throat and then well if that comes back negative we will go from there and think about other viral causes versus strep throat as well.
D: Did you have any questions or anything that I missed that you wanted to discuss today?
P: Um, no. We were thinking that it could be, uh, maybe strep throat. So um, yeah, thank you.
D: OK, great, thank you. |
dataset\resampled_file\RES0038.wav | D: So what brings you here today at the family clinic?
P: I haven't been coughing these last two weeks since I got back from Mexico. I think I got sick there.
D: OK, so just the last couple weeks you've been coughing?
P: Yeah, ever since I got back from Mexico it's been yeah so about about two weeks.
D: OK. And is your cough for a wet cough or dry cough?
P: It's dry and I'm not bringing up any any sputum.
D: OK, and are you coughing up any blood at all?
P: No blood.
D: No, OK. And is the cough constant or does it come and go?
P: It, it comes and goes. I would say sometimes it can be worse. Yeah, depending on on what I'm what I'm doing. I guess if I'm exercising or if it's if it's really cold outside, it might get worse.
D: OK. And do you feel that it's been getting worse at all, your cough?
P: Uh, not really, I think it's about the same.
D: OK, and anything that you did when you were in Mexico that might you think might have caused your cough?
P: Uh, I don't know, maybe I, I was drinking a little bit too much and partying a little bit too much so might have got sick while I was there.
D: I see. Did you have any cold symptoms like runny nose, sore throat? Um, any anything like that when you were there or after you came back?
P: No, sometimes my eyes can get a little itchy, but no runny nose or sore throat.
D: OK, have you had any previous episodes that are similar to how you're feeling now?
P: Uh, maybe years ago when I like when I was in elementary school, but nothing for the last few years.
D: OK, and how often are you coughing? Let's say in an average day?
P: Um, it's uh, it's pretty variable. I would say, so if I'm exercising it will it'll throw me into a coughing fit and and sometimes it's really bugging me at night too it'll affect me. It's impairing my sleep.
D: OK, and so exercise makes it worse. Anything that you do that helps you relieve the cough?
P: Uhm, I actually I tried my sons inhaler and it seemed to actually help, but one of the days I just couldn't seem to stop the cough and I wanted to sleep so I gave it a try and it it seemed to actually help with the cough.
D: OK, and so your son has inhalers, does he have asthma?
P: Yeah he does. Yeah he was diagnosed with asthma a couple of years ago.
D: OK, and have you previously been diagnosed with asthma?
P: Ah I think if they've said it before when I was young, but I haven't had any symptoms for for for years.
D: OK, and besides the cough, do you have any other symptoms, like any cold symptoms of runny nose, sore throat right now, or even like any chest pain?
P: No, nothing like that.
D: OK. And do you have any symptoms like a headache or nausea or vomiting?
P: Uh, nope. No headache, nausea or vomiting.
D: OK. Is your cough at all worse during the day or at night? Or does it just is at around the same throughout the day?
P: I think the coughs worse at night.
D: OK. And do you ever feel that you're short of breath at all?
P: Well, yeah, so it affects me if I'm outside and that that's actually usually when my eyes will get itchy too.
D: OK. And have you had any eczema in the past?
P: Uh, yeah I had, I had eczema when I was I was younger. I think that was in it when I was in elementary school as well.
D: OK. Have you had any fevers or chills recently?
P: No.
D: Any night sweats?
P: No.
D: Have you been feeling increasingly tired throughout the day?
P: Ah no, my energy's been been good I just get short of breath or or have these coughing fits if I, if I exert myself.
D: OK, have you noticed any swelling in your feet or hands?
P: No.
D: Any dizziness?
P: No dizziness.
D: Do you ever feel your heart is racing when you get like these thumping like heart palpitations?
P: Uh, nothing like that.
D: OK, and you said no chest pain, right?
P: No chest pain.
D: OK. Have you noticed any changes in your bowel movements? Any constipation or diarrhea?
P: No diarrhea.
D: OK. Any changes in your urinary patterns?
P: No, everything's been normal.
D: OK, so you mentioned like the coughs been keeping you up at night. How, how often are you waking up at night? Is it pretty frequent?
P: I would say about two or three nights a week over these last two weeks. It's been, it's been getting worse.
D: OK. And have you noticed any changes in your weight at all?
P: My weight's been about the same.
D: OK, any changes in your appetite?
P: No, been eating well.
D: OK. Any recent exposures to anyone with tuberculosis that you know of?
P: No.
D: No, OK. Have you lost your sense of taste or smell recently?
P: Neither of those.
D: OK. And have you been exposed to any fumes or dust in your surrounding area, or do you have any pets or animals at home?
P: Um, yeah, we have a, uh, two cats. And, but nothing at work.
D: OK. And how long you've had those cats for?
P: We've had them for for almost a year.
D: OK. And other than eczema and remote history of perhaps asthma when you were younger, any other medical conditions like diabetes or high blood pressure that you've been diagnosed with?
P: No, I've been healthy that way.
D: OK. Any medications that you are on currently?
P: Uh, no medications.
D: OK, do you know of any allergies to any environmental exposures or any medications at all?
P: Uhm yeah, I think I have, I'm allergic to pollen and some other environmental and allergies as well.
D: OK, and when you cough, have you ever noticed like wheezing noises at all?
P: Uh occasionally yeah, there, though I do notice a wheeze.
D: OK. And have you ever been hospitalized before?
P: No, I haven't.
D: Ok, any previous surgeries?
P: No surgeries.
D: OK. And has anyone around you been ill recently?
P: Everybody's been healthy.
D: OK. And do you have any family history of cancers or anything related to the lungs at all?
P: Uh, no. I mean, my sister had eczema as well, but that's it.
D: OK, that's it. OK, uh, any heart attacks in your family? Any other medical conditions?
P: Uh, no. Everyone's healthy.
D: OK and currently what is your living situation like?
P: Yeah, so I live in an apartment nearby with my boyfriend.
D: OK, and has there been any, have you moved there recently or how long have you lived there for?
P: Uh we've lived there for about four years now.
D: Four years, OK. And has anything changed recently? Has there been any mold or new carpets that you guys got anything new in the house?
P: Uhm, I don't, I don't think so.
D: OK. And do you currently work?
P: Yeah, I work as a a school teacher.
D: OK. And do you smoke at all?
P: No, I don't.
D: Have you ever smoked?
P: I did, yeah I, I smoked a pack a day up until just about a month ago. I made, it was a New Year's resolution to quit.
D: Oh wow, well congratulations, that's it's definitely very difficult to quit. And if you need at all, any help at all with your transition at all, we can always bring it up in any appointment.
P: OK, thank you.
D: Yeah. And in terms of recreational drugs, do you use marijuana or cocaine or any other recreational drugs?
P: Um, yeah, maybe I'll I'll smoke like one or two joints a week.
D: OK. And do you drink alcohol?
P: Uh, yeah, maybe a bottle of wine on the weekends.
D: OK. Uhm, so you go through like around a bottle every week?
P: Yeah, I would say about a bottle of wine on throughout the week, but usually don't really have any during the week, I'll usually, I guess, split the bottle between between Friday to Sunday sort of thing.
D: OK. And in terms of exercise, do you find that you're getting adequate exercise throughout the week?
P: I tried to, I tried to run and go for walks but always trying to be a little bit more active.
D: OK. Alright, so yeah those are all the questions I had for you today. Um, do you have any other questions for me?
P: Uhm, nope, that was it.
D: OK, so based on what we talked about, it seems that based on your past history and the coughing that you're having right now, one of the things that we definitely want to look at is if you do in fact have asthma. Um, it can also be like viral upper respiratory tract infection, but we will do some pulmonary function tests for you and see if the bronchodilators just like you use the inhaler from your son if that helps helps you with your symptoms and then we can go from there.
P: That sounds great. Thank you.
D: You're welcome. Well, take care. |
dataset\resampled_file\RES0108.wav | D: What brings you in?
P: Hi. Uh, I've just had this cough for the past week and I was worried I might have Covid so I just wanted to um I just wanted to be checked.
D: Sure, so you mentioned you, it started a week ago.
P: Yeah.
D: Has it been persistent or does it come and go?
P: Um it's just been there.
D: Been there. OK.
P: Yeah, I just get this itchy sort of uh like scratchy sensation in my throat. And then I just cough and um that makes it better.
D: OK. OK, uhm what, how would you describe your cough like is it barky? Is it harsh? Is it muffled?
P: Uhm no, I don't I don't think it's barky or harsh.
D: OK, and does anything make it better or worse like you know, like the cold air, laying down, at particular time of day?
P: Not really, I haven't uh, nothing's really helped. Um I also tried a cough syrup, um it didn't, it helped for a couple hours, but then it was back again. The cough was back again.
D: OK, and have you ever experienced anything like this in the past?
P: Uh well, I I said yeah when I get a cold.
D: Mhmm, OK.
P: Once a year maybe.
D: Once a year? OK. Um do you experience any shortness of breath with this cough?
P: No.
D: No, OK. Is it a dry cough or do you bring up any phlegm?
P: No, it's a dry cough.
D: OK, uh any blood that you've seen?
P: No, no.
D: No, OK. And do you feel wheezy?
P: No.
D: No, chest pain?
P: No.
D: No, um feeling like your heart's racing?
P: No.
D: Any swelling in your limbs?
P: Uh no.
D: No, any fainting spells?
P: Uhm, no.
D: No, OK. Do you ever feel like your nose is stuffy or runny?
P: No.
D: No, any changes in your vision or hearing?
P: Uh no.
D: A sore throat?
P: No.
D: Um loss of smell or taste?
P: No.
D: Any weight loss?
P: Uh no.
D: Fevers?
P: I checked no, no, I don't have a fever.
D: No, any rashes?
P: No.
D: Issues uh, any changes in your bowel movements?
P: Um uh no, I've just been constipated from time to time, but that's nothing, that's not new.
D: OK, constipation. And I'm sorry when did your constipation start?
P: Oh it's a problem for years. I don't eat enough fibre.
D: Oh, OK. Any changes in your urine?
P: No.
D: OK, any nausea or vomiting?
P: Uh, no.
D: No, OK. Any joint pain?
P: No.
D: No, numbness or tingling?
P: No.
D: Headaches?
P: No.
D: No, OK. Are you otherwise healthy? Do you have any longstanding medical conditions?
P: I have diabetes.
D: OK, how long have you had diabetes?
P: It's about, it's been uh seven years now.
D: OK, any hospitalizations or surgeries in the past?
P: No.
D: OK and um how about medications? Are you on any?
P: Uh yeah, I've been taking uh metformin for the past uh, for the past five years, when, five or six years.
D: OK.
P: Um and uh my family Doc started me on uh ramipril about two weeks ago, he told me that uh now that I'm 50, I need to I need to be on this pill as well, so now I have to take 2 pills instead of one.
D: OK.
P: Yeah because I think it's it's good for my heart or something.
D: Yeah, for sure. So you started that two weeks ago, OK. Are you up to date with all your immunizations?
P: Uh yeah, I think so.
D: OK, any allergies?
P: Uhm penicillin, I just get uh I get a rash. I got a rash when I was a child, I haven't had it since then.
D: OK, OK. Any family history of lung or heart conditions?
P: Uh no, nothing like that.
D: No, OK. Do you smoke?
P: Uh, no.
D: No, how about, uh, marijuana or other recreational drugs?
P: No.
D: No, OK, um alcohol?
P: Uh yeah, I drink on the weekends.
D: OK, what do you drink and how much do you drink?
P: I'll have maybe two or three uh bottles of beer.
D: OK sure, and um have you been in contact with any sick people recently?
P: No, no, I've just been staying at home.I'm just scared of covid, but I'm I'm still worried I might have somehow gotten it.
D: Yeah, for sure. Uhm, any travel recently?
P: No.
D: No, OK. And where do you live right now?
P: I live in a house with my wife and my two kids.
D: OK, uh are they healthy?
P: Yeah, they're all healthy.
D: OK. Any old carpet, dust, mold, or asbestos in your home?
P: Um not that I'm aware of.
D: No, OK. OK, well it seems like um those are all the questions that I had for you today. Did you have any questions of your own?
P: Uh no, I just want to get tested for Covid.
D: Yeah, so we will definitely do a Covid swab on you because you have a cough, um and those results should come back to you in about 24 to 48 hours, and so you'll know more then. But because your symptoms do overlap with that of Covid, we still recommend isolating for 14 days. But the other thing I want to mention is that you don't have any other symptoms of infection besides your cough, and it seems like the cough started a week ago and you started this new medication ramipril two weeks ago, and so ramipril is a type of ACE inhibitor and one of its side effects is that in some people it can cause coughing. So, I am going to review your medications and if your family Doc also agrees, we may try uh another um blood pressure medication for you instead of ramipril.
P: Sure.
D: Um so we'll try and change that medication and see if your coughing stops. How does that sound?
P: Sounds great.
D: OK, great, thank you. |
dataset\resampled_file\RES0054.wav | D: What brings you in?
P: Hi, uhm, I've just been a little bit worried, that last the couple of months I've noticed that I've been getting more and more out of breath when I've been doing exercise, and I know I got a brother who had a heart issue and I'm just really concerned that I have something wrong with my ticker, just wanted to get it checked out, you know?
D: Uhm, when did the shortness of breath start?
P: So, this winter specifically, like we haven't been too active because of Covid this year, we've just been staying in the house all last year, but with the snow, I'd be shovelling snow whenever it fell and before I could be able to like 2 years ago be able to clear the driveway, no problem, but now even after half the driveway I've noticed I'm getting consisntely out of breath, I've got this nasty cough and it's prompted my wife to get me to call in, she's a little bit worried.
D: So it's mostly on exertion, it doesn't happen at rest, is that correct?
P: Being out of breath? No, no.
D: No, OK, ok. And has this ever happened to you before?
P: Yeah, about a year and a half ago we went down to Toronto, in order to see the CN tower, and you know, do tourist stuff and we tried we tried to climb a couple flights of stairs to do a little bit, and I could not, I always thought I'm pretty healthy, pretty active but it really took the wind out of my sails, so had to stop, stoop over. Just couldn't do it.
D: Uhm, and how did you manage like how, how was that treated at that time and how did you get better?
P: Oh, I didn't do any. I just attributed to being, I don't know, out of shape a little bit and I worked as a mechanic when I was younger. I was pretty active, but ever since retiring thought I'd keep up, at least my stamina won't go away that quickly, but chalked it up to being out of shape and went home.
D: OK. Uhm, so your symptom, your shortness of breath seems to be getting worse, right?
P: Yeah.
D: OK, any coughing with that?
P: Yeah, yeah. And not necessarily when I noticed it when I was shovelling the driveway. But I've had a call for the last couple of years and usually in the morning I just bring up a little bit of gunk, but most of my buddies have that, just like a morning cough, you know?
D: Yeah, and the gunk that you bring up. What color is it?
P: Uh, yellow, sometimes a little brown.
D: OK, and when did that start?
P: Oh, it's been going on last 10 years. Well, to be honest since I've been like 30, but it's been fairly consistent, last 10 years I'd say.
D: OK, any blood that you bring up?
P: Not that I've noticed, like bright red? No, nothing like that.
D: OK. Any wheeziness?
P: Yeah yeah, I noticed that when I was showing, yeah when I was out of breath, it sound sounded different sound different than being usually out of breath but it had to. It sounded wheezy.
D: OK. Any chest pain?
P: Yeah, a little bit actually.
D: Uhm, at rest or?
P: Nothing, nothing when I'm not moving.
D: OK, so the chest pain, when did that start?
P: First noticed it this winter on the driveway but it wasn't like I know what they say about a heart attack, supposed to like, the crushing pain in your chest that moves up your neck. Nothing like that. It's like my lungs, my throat. Like you're really, really out of breath, you know?
D: OK, so you're attributing it mostly to your shortness of breath then?
P: I think so. I really hope this is my heart. I've never had a heart attack.
D: Yeah. Where in your chest is this chest pain happening like is it central? Is it more towards the left, towards the right?
P: It was kind of both sides.
D: OK.
P: It was, Was we all across my chest, to be honest it was only the one time that was really struggling and I coughed up a bit, but yeah.
D: OK, any pain in your calves or legs, well after you walk a certain distance?
P: No, no.
D: No. Do you ever feel like your heart's racing?
P: Felt like my heart was racing after that much activity, but no, not usually.
D: OK. How about swelling in your limbs?
P: No, nothing like that.
D: OK, any fainting spells or dizziness?
P: No never fainted in my life.
D: OK. Any confusion, memory loss?
P: No, nothing like that.
D: Headaches?
P: Headaches, you know I do get headaches from time to time. I associate them with stress, but I haven't been too stressed out recently so nothing in the last couple of years.
D: OK, any neck stiffness?
P: Uh, no.
D: No, OK. Any sensitivity to light or loud sounds associated with that headache?
P: No, nothing like that.
D: OK, any weight loss?
P: No, I wish.
D: OK. Fevers?
P: No.
D: Rashes?
P: You know I got these weird things on my head. I think mainly because of the sun. Like these brown patches, but that wouldn't be a rash, would it?
D: I'd have to examine that closer. If you think it's associated with the sun, it could be something like seborrheic keratosis, but I'd have to see what they look like so we can take a look at that later, if that's OK. And so any changes in your vision or hearing?
P: No.
D: No. Stuffy nose, runny nose?
P: Had a bit of a cold couple months ago, but no, nothing recent.
D: Sore throat?
P: Yeah, a little bit after the cough. I had a little bit of a sore throat but went away pretty quickly.
D: OK. Change in smell or taste?
P: I haven't been able to smell or taste too well for awhile.
D: What's awhile?
P: Ten years, seven years it's been more salt, more spices on my food, you know.
D: OK, OK. Any changes to your bowel habits?
P: Nope, been regular all my life.
D: Nausea, vomiting?
P: No.
D: OK. Joint pain, muscle aches?
P: You know my knees been giving me trouble for awhile, but nothing recent, no.
D: OK, and are you otherwise healthy?
P: No, got high blood pressure. See the doc about that. Uhm, high cholesterol, see the doc about that. And yeah, I don't know. Got into a car crash my 40s. Broke my arm one time. Nothing else really.
D: OK, any surgeries?
P: Uh, I think I had my appendix out when I was, yeah I had my appendix out when I was like 12.
D: OK.
P: Never been under the knife since then.
D: OK, great. Have you been taking any medications for that high blood pressure?
P: Yeah doc's got me on two blood pressure medications and one cholesterol medication.
D: OK, and do you take those frequently?
P: Yeah, everyday.
D: OK, good. Any other medications?
P: No.
D: Are you up to date with all your immunizations?
P: Jeez, been a while since I've gotten immunization. Think, I think so.
D: OK. Once you turn 65, they usually give you shing-shingrex for, to prevent shingles and a pneumovax vaccine to prevent pneumococcal infections. Have you had those ones?
P: Nope.
D: No, OK. So if you're interested in getting those, we can discuss that at some point today as well,
P: OK.
D: Do you have any allergies?
P: No.
D: No, OK. Any, OK, so you mentioned a family history of your brother having congenital heart disease. Any other heart diseases that run in the family?
P: Congenital. What's that mean?
D: Like something that you're born with.
P: No, I don't think he's ever born thing he had a couple of heart attacks.
D: Oh heart attacks. OK sorry I must have misinterpreted that. How old was he when he had his first heart attack?
P: He's older me by five years, but he had the first one when he was younger than I am now. Like 62 was the first one, another one at 65.
D: OK. Uhm, did, is he, did they ever find a cause for his heart attack? Is he a healthy person?
P: Healthy, he's healthy. I you know I wouldn't call him too healthy of a guy either. He's a hard liver, let's call him that. I have why it happened, I think, obviously it's his diet man. He's like a hog. Steaks, butter, bacon I'm assuming that's what did him in.
D: Oh yikes, OK. OK, uh any other heart conditions that run in the family or other members of the family experiencing heart attacks?
P: Yep, dad died young from a high heart attack. He was, he died younger than I am now. He passed away at 66.
D: Oh, I'm sorry to hear that.
P: Oh it's been years now. It is what it is. His grandmother had a stroke. High blood pressure on my mom side. High cholesterol on my mom side too. But yeah, awful heart attacks on my father side of the family.
D: OK. Any other lung, any lung conditions that run in the family?
P: None that come to mind.
D: OK and do you smoke?
P: Yeah, yeah I smoke.
D: OK, how much do you smoke?
P: I cut it back, about half a pack a day for the last two years now.
D: OK and before that?
P: I was pretty much a pack a day. Maybe, well, when it was bad, 2 packs a day, but I've been smoking yeah, since about, when do they start working at the shop, like 17, everyone there smokes.
D: Oh OK Wow yeah well then but it's good that you cut down, that's good. Do you, do any other recreational drugs like marijuana, cocaine, heroin, anything?
P: I'll smoke weed at the shop every Friday, but I'm not huge fan of it to be honest.
D: OK. And how much do you smoke every Friday?
P: Both are about four joints, seven people, so I don't know what that is. Half a gram?
D: Half a joint? OK, yeah. OK, and do you drink?
P: Oh yeah.
D: How much do you drink?
P: See, Christmas was about the last time I went out like a beer or two. Uhm, weekends but when families in town will we'll go whole hog. I'll drink maybe 20 beer.
D: Oh OK, OK. And yeah you should, have you thought about cutting that down?
P: You gotta keep up with the family, you know, you can't let them embarrass you like that.
D: Let's, I understand that, but also you know, it's important to take care of your health and slow and steady wins the race, right?
P: I'll keep that in mind, doc, I'll keep that in mind.
D: Yeah, and how's your diet?
P: Been pretty good. The wife's been on a, on a health food craze last five years. Vegetables, I don't know, I eat whatever she cooks, basically.
D: OK. Uhm that's good, and in terms of exercise, do you get to move around?
P: I used to be pretty active. I used to bike around, but 'cause of Covid I've just been indoors all this time. So no, not much.
D: OK. OK, well it's good to go out for a walk once in awhile. I think that's allowed during Covid as long as you're being safe. And who do you live with at home?
P: I live with my wife.
D: OK, any children?
P: Yeah, I've got three kids, one for my first marriage, two with the Mrs. right now.
D: OK, and do you get to see them often?
P: Yeah, daughter lives in town and get to see her and grand kid a bit, the other boy works in Fort Mac and my oldest son, he's out east.
D: OK, OK, and have you had any contact with people who've been sick recently?
P: No, we've been keeping entirely to ourselves. You can get our groceries ordered to the house.
D: OK. And how about travel? Any recent travel?
P: No.
D: No, OK. Uhm, and then lastly, just wanted to ask you because you have been smoking for a long time, have you ever been diagnosed with something called COPD?
P: Doesn't ring a bell.
D: No, OK. Have you ever had any pulmonary function tests or chest x-rays done in the past?
P: Chest x-ray, I think they did a chest x-ray after the car crash.
D: OK.
P: But I can't think of getting one recently, no.
D: OK. Alright well those are all the questions that I had for you. Did you have any questions for me?
P: So this is a hard, like, should I be worried?
D: Yeah, you know what? It sounds from what you're telling me, it sounds like you have shortness of breath on exertion, and it sounds like you have a cough with still producing some phlegm. It doesn't seem like you have any systemic symptoms of infection, so I'm not too worried about that. And then in terms of your heart, you mentioned you had that chest pain once, but it really does sound more like a lung problem to me than a heart problem to me right now, but of course we'll do all the necessary investigations to rule out any heart stuff. But right now, I'm thinking it could be something called COPD, chronic obstructive pulmonary disorder because of your smoking history. Uhm, so we'll start with doing a pulmonary function test and chest x-ray, and I we'll try to go from there. If it is COPD we'll likely put you on a, like a puffer for that. A like a lot a short or long acting beta agonist, that's what it's called. So if your symptoms don't get better with that, we'll do other investigations to try to figure out what this is. How does that sound?
P: Sounds great, doc. Thanks a million.
D: Alright, great thank you.
P: Have a good one. |
dataset\resampled_file\RES0049.wav | D: What brings you in?
P: Yeah, nice to meet you I, I've been having just over the last week my cough that's been getting worse and I had a fever a couple of nights and just yesterday I noticed that I started having a loss of taste and smell so that got me really worried.
D: OK, so yeah, let's rewind a little bit. The cough you said started a couple of weeks ago, so would that be about 2 weeks? Three weeks?
P: I would say last week, so like 7 seven days ago.
D: Seven days ago, OK. So that started seven days ago and then when did the fever start?
P: The fever I hasn't been constant, but I've like had some nights where I just feel really chilly and then during the day sometimes even getting these chills I've been recorded at a temperature, but I think I've had a fever at least three times in the last week.
D: OK, so you haven't actually taken your temperature, but it you just feel like you have chills?
P: Yeah.
D: OK, we could take your temperature today. And then the loss of smell and taste. Do they both happen at the same time?
P: I think the taste happened like before, but that was just yesterday and then yesterday morning like at breakfast, I couldn't really taste anything and then continued during lunch and dinner, but smell, I kind of lost around the evening.
D: OK.
P: Yeah, all just started yesterday.
D: OK. Um alright, so let's go back to the cough and has it been constant since it started?
P: Yeah, it's been pretty constant. It's been getting worse, especially like in the last few days. I'm mainly coughing like before I was coughing mainly at night, but now I'm coughing throughout the day.
D: OK, um so yeah, you mentioned possibly a trigger would be like time of day at night? Or did you notice any other triggers like you know, the cold air or dust or anything at home that could be potentially triggering your cough?
P: Uh no, not really. Like I've lived in the same place for awhile, no new changes and I've been barely going outside, so I don't think there are any triggers.
D: OK, and in terms of the quality of your cough is that, would you say it's harsh? Barky?
P: Uhm, I would just say it's like kind of harsh at times, but mainly it's a dry cough, like I'm not bringing anything up.
D: OK, OK. And then you said dry cough so no sputum or blood right?
P: No.
D: OK. Have you ever experienced anything like this in the past?
P: Not the loss of taste and smell, but like the other stuff when I just had a cold or flu like symptoms previously, but the taste and smell is something completely new.
D: OK. And then, um, have you experienced any shortness of breath?
P: Um, not really, no.
D: No, OK. How about we wheeziness?
P: No.
D: Chest pain?
P: No chest pain.
D: OK. Uh, experienced any weight loss recently?
P: No, not that I know.
D: OK, how about fatigue?
P: I have been a bit tired in the last few days. The fevers at night and morning. Just feeling a little bit crummy, just not really energetic, energetic to do anything.
D: Yeah, for sure.
P: Just been planner, just sitting on the couch.
D: OK. Any changes to your hair, nails, or skin, like rashes?
P: No, I haven't noticed anything like that.
D: OK, you mentioned loss of smell. Do you have a runny nose or a stuffy nose?
P: I did have a runny nose earlier this week, but that's kind of subsided. Other than that, I don't really feel too much congestion. I've been taking Tylenol, the Tylenol cold so I don't know if that helped.
D: OK, how often are you taking the Tylenol cold?
P: I just took it like for four days just before going to sleep in the last week.
D: Oh, I see. OK. OK and then. Any I do have a sore throat?
P: No.
D: No, ok. How about any changes to your vision or hearing?
P: No, nothing like that.
D: Any pain or discharge in the eyes or ears?
P: No.
D: OK. Do you ever feel like your heart's racing?
P: Uh no, not really.
D: No, OK. And any swelling in your limbs?
P: Uh, no, I don't think so.
D: OK, any dizziness or fainting spells?
P: No.
D: OK. Confusion or memory loss?
P: No, not that I can tell.
D: OK, any changes in your bowel habits like constant constipation or diarrhea.
P: Oh no, not really.
D: No, no blood in the stool, right?
P: No.
D: OK, any changes to your appetite?
P: Um, just maybe in like a little bit with the loss of smell and taste, the food is not really the same in the last day, last few days?
D: Yeah yeah, that makes sense. Any nausea or vomiting?
P: No.
D: No, OK. And any changes in terms of urine?
P: No, I've been peeing alright.
D: OK, good. Any major or a longstanding medical conditions, or are you otherwise healthy?
P: No, I've been fortunate otherwise healthy. I had asthma as a kid, but like I haven't had to use the puffers for more than a decade.
D: Oh ok. OK. And what triggers your asthma?
P: I think back then it was just when I did sports and I was running around a lot. I've been fine for the last 10 years at least.
D: OK. OK, that's good. And any surgeries or hospitalizations in the past?
P: No.
D: No, OK. Any are you on any medications?
P: Currently just the other thing, Tylenol cold, but other than that no other medications.
D: OK, not even other over the counter medications or herbal supplements?
P: No, nothing like that.
D: OK. Do you have any allergies?
P: Um, sometimes in the fall like I get a bit sniffly and, but other than that, I don't know of any allergies to any foods or medications.
D: OK. And how about immunizations? Are you up to date?
P: Yeah, they're all up to date.
D: Any lung conditions or heart conditions that run in the family?
P: Uh, my father did recently have a heart attack at age of 58 I think he was, he, he's fine though, but that's that's about it.
D: OK, um any cancers that run in the family?
P: Um, no, I don't think so.
D: OK. And, and do you smoke?
P: Uh, yeah, yeah I do.
D: OK, how much do you smoke?
P: Probably, I would say a pack a day.
D: Pack a day, OK. For how long?
P: Ah, probably since in my 20s, so at least 10 years now.
D: OK, have you ever thought about cutting down?
P: Yeah, especially with this pandemic going on, it's been, I've been trying to cut down just because like I don't want to get the, get COVID and then you know my lungs are probably already weaker because of the smoking. So I've been trying to cut down.
D: Yeah, for sure it's good that you're trying to cut down. We have resources to help you if you ever need them.
P: Yeah, for sure.
D: Do you do marijuana?
P: No, no, I've never tried marijuana.
D: OK, how about other recreational drugs?
P: No, um, besides alcohol, nothing else.
D: OK, and then um, I guess I'll ask you about the alcohol, uhm, how much do you drink?
P: Um, um, not that much. I'd probably say like a few times a week when there's a game on. I just grab a couple of beers, but that's about it.
D: OK. Uhm, and where do you live right now?
P: Yes, I just live just outside of London with my wife and daughter in a small townhouse.
D: OK and anyone else at home sick?
P: No. I I've kind of stayed away once I noticed some symptoms. I'm just kind of just staying in my room, not getting out. I don't wanna make any of my families like.
D: Yeah, that makes sense. And have you traveled to anywhere recently?
P: No, umm, I haven't really traveled. I do I do go to work though I haven't in the last last week. I've told them that I've been having these symptoms, but other than that, no traveling.
D: OK. Uhm, OK, that's good. Those were all the questions I had for you today. Was there anything that you wanted to ask me or anything else that you wanted to discuss that I may have missed?
P: Uh, yeah, I I that I'm just wondering like I could it be COVID I I don't know. I don't know if someone in the office had it or yeah, it was just basically worried about, if I had COVID.
D: Yeah for sure. that's definitely something that we need to rule out, so we will be doing a COVID swab on you and and you will hear back in about 24 to 48 hours with the results. But regardless, because your symptoms overlap with symptoms of COVID especially umm, the loss of smell and taste, we do recommend that you isolate for 14 days and that includes trying to isolate from family members as well. So we'll, that's where we'll start. If it's not COVID, it could be another viral illness that's going around at this time of year. But, we'll start with, we'll start with these COVID swabs. How does that sound?
P: Yeah, that sounds good. I'll, I'll let my work know and yeah, hopefully it comes back negative, but I'll stay away from everyone till then.
D: OK, sounds great, thank you.
P: Alright, thank you so much. |
dataset\resampled_file\RES0189.wav | D: How may I help you?
P: So I've been having a lot of trouble in the last two weeks of especially this past week of just a lot of shortness of breath. I'm getting a lot of coughing as well and producing a lot of material. And also I think I might have been having a fever this week as well.
D: OK, uh, the shortness of breath is it happening at rest or exertion and how much exertion?
P: Uhm, I think it's happening mostly on exertion. Usually I'm able to walk around the house, no issues, go up and down stairs, but right now I'm pretty limited. I can't really go up and down stairs without getting really short of breath. I can't even walk from the bedroom to the kitchen without becoming shortness of, like short of breath.
D: OK, um OK, and when did that change happen?
P: So I would say one week ago is when this all kind of started.
D: OK, and has it been getting any better, worse, or staying the same?
P: I would say it's kind of getting worse. I'm coughing a lot more sputum up. I'm getting more and more short of breath. Now, I do have a call for like a very long time now I've I was diagnosed with COPD in my 60s. Probably like 10 years ago and but this seems to be just a much worse than my COPD.
D: OK, sure it's been a lot worse in the last week it sounds like. OK. Uhm have you, are you able to lie flat? Like on your back without experiencing shorter breath, shortness of breath?
P: Yeah, and when I'm resting or lying down or trying to sleep I don't get short of breath.
D: OK, and have you ever had instances where you woke up in the middle of the night really short of breath and you had to sit up to catch your breath?
P: Uh no, I don't think so.
D: OK, have you noticed any leg swelling?
P: No.
D: OK, and you said that to you, so you've had a cough for awhile now, but it's gotten worse. This past week in your, are you bringing up sputum?
P: Yeah, I'm bringing up a lot of materials. I think every time I cough I'm bringing some sputum up and right now the like usually the color is like clear to whitish but right now it's a bit more yellow.
D: OK, so a change in the sputum color and also sounds like you're bringing up more sputum as well.
P: Yeah.
D: OK and have you brought up or coughed up any blood? So have you had any hemoptysis?
P: No, nothing like that.
D: OK, and have you had any wheezing?
P: Uhm, I do but when I get short of breath I have some wheezing, but usually I don't.
D: OK, but but you've had wheezing this past week though.
P: Yeah.
D: Yeah OK. And have you had any chest pain?
P: Just when I'm coughing and getting short of breath, I do have some discomfort in my chest.
D: OK, uh, do you feel that, or could you describe he the pains character? Like is it sharp, dull, or achy?
P: It's more just an ache and it's kind of more of a discomfort than a pain, and it kind of goes away once my episode of coughing and shortness of breath is relieved with some rest.
D: OK. Uh, and uh, have you been experiencing any fevers or chills?
P: Yeah, I've been noticing that I'm getting a lot more chills this past week. They kind of come and go, but even at night I get like these chills that after wrap myself up in at least three blankets.
D: OK, and have you had a fever?
P: Uh, I didn't get a chance to measure any of them, but I might have had a fever just from the chills that I'm expecting that I had a fever.
D: OK, and have you had any night sweats?
P: No.
D: OK and have you had any unexpected weight loss over the last several months?
P: No, I think my weights been pretty steady.
D: OK. Have you had any headaches?
P: No.
D: Have you had any like eye redness or eye discharge?
P: No, not that I know of.
D: OK, have you had a runny nose or a sore throat?
P: No.
D: OK, have you had a loss of taste or loss of smell?
P: No, nothing like that.
D: OK. Have you had any nausea or vomiting?
P: No.
D: Have you had any abdominal pain?
P: No abdominal pain.
D: Have you had any diarrhea?
P: No.
D: Have you had any constipation?
P: No.
D: Have you had any skin rashes?
P: No.
D: Any muscle aches or joint pains?
P: No, nothing like that.
D: OK, and have you had any any fatigue?
P: Maybe a little bit more tired just with the shortness of breath and chills and everything like that, but yeah, so a little bit more fatigue.
D: OK, and have you had any fainting or dizziness?
P: Uh, no.
D: Or, OK and have you had any heart palpitations?
P: Nope.
D: Alright. And have you been diagnosed with any medical conditions in the past?
P: No. Oh sorry, medical conditions in the past? COPD I have. I also do have some high blood pressure and I take some medications for cholesterol as well.
D: OK, so you take medications for cholesterol and high blood pressure and you use any inhalers?
P: No. Sorry, inhalers I, use, uh, two different kinds of inhalers. So one of them is just when I like need it, uh, like I've been using a lot more recently, like the Ventolin. And then I also have another inhaler called Spiriva that I've been using as well.
D: OK, and do you have any allergies?
P: Uhm I do have an allergy to sulfa drugs.
D: And what reaction?
P: I usually break out into hives.
D: OK, and any prior surgeries or hospitalizations?
P: So I've had a surgery to remove my appendix when I was really young. Then I've had another surgery for my hips as well, but yeah, other than that, no other issues.
D: OK. And are your immunizations up to date?
P: Yeah, all of my immunizations should be up to date.
D: OK, excellent and could you tell me a little bit about where you're living currently and who you're living with?
P: Yeah, so I, I currently live alone in, in an apartment just in the city. And yeah, I've been living alone for probably the last five years.
D: OK, and have you been around anybody who's been sick?
P: Uhm, not recently. I think I just I just go out to get groceries and stuff. I haven't really been going out too much.
D: Alright, So have you traveled anywhere?
P: No.
D: OK uhm, do you drink alcohol?
P: Maybe a couple of years a week.
D: OK, and do you smoke cigarettes?
P: Yeah, I still smoke cigarettes. Even though I have COPD, I just yeah, I can't really quit. I smoke probably half a pack a day.
D: OK, how long have you smoked for approximately?
P: Uh, probably at least 45 years.
D: OK and uhm, if you wanted to talk about quitting, we can discuss that further at a later time if you'd like. Uhm, and so do you use any recreational drugs?
P: No, no no no drugs at all.
D: OK. Uhm, and have you had a family history of heart disease or any lung conditions?
P: Uhm, not, I mean like no lung conditions, but I have a family history like my both my grandather and father both had heart attacks in their 60s.
D: OK, and any lung cancer in the family?
P: No, not that I know of.
D: OK. So I think that was all the questions that I I wanted to ask today. Was there anything else that I maybe forgot about that you wanted to mention?
P: Uhm no, I think that those are all the questions I had and everything was covered.
D: OK, uhm so uh, the next steps for now, I think, will be to, uh start, we'll get a physical exam in and your vital signs and get some investigations. It is sounding like a COPD exacerbation with the increasing and the change changing sputum. The increasing frequency of cough and the exertional shortness of breath as well, along with wheezing and kind of this chest discomfort that you're experiencing. And so, uh, this will require some antibiotics as well and depending on the severity of symptoms, possibly some steroids as well to help with the inflammation.
P: OK, that sounds good. Thank you. |
dataset\resampled_file\RES0018.wav | P: I've just been having this this cough over the last few days and I also notice that I'm getting like these headaches and chills as well at night. So I was just a bit concerned.
D: OK, so the cough started a few days ago. Have you been bringing up any phlegm?
P: No, not really. It's been pretty much like a dry cough. I did feel like a tickle in my throat before it started, but no, I'm not producing any phlegm.
D: OK, um is the cough any worse at any particular time of day, like when you first get up or or at night when going to bed?
P: No, it's pretty much just been there over the last, at least like 2 days. It's been getting worse, more frequent.
D: OK, so um and are you coughing all throughout the day?
P: Pretty much, at least for the last few days. Just it's been pretty nonstop.
D: OK, anything that's made the cough worse?
P: Uh, no, not really. It's uh, pretty much been the same for the last few days.
D: Anything you've tried to make the cough go away?
P: Just like Tylenol cold. And then I think there was another over the counter medication that I took, but nothing really helping.
D: OK and uh, the cough has been been getting worse. Have you been experiencing any other symptoms?
P: Um, I did just just last night, actually. I thought that I had some shortness of breath as well. I don't know if that's being caused by all the coughing, but yeah, I got pretty scared, so that's why I'm here today.
D: OK, um has anything like this happened to you before?
P: No, like I've been pretty healthy otherwise completely so this is this is completely new for me.
D: Ok, and yeah, you mentioned you had a fever but did have you checked your temperature?
P: No, I haven't I I just had like chills over the last two nights. Just had to put on like 3 three blankets just to get to sleep, but I haven't really checked my temperature.
D: OK, I have you had night sweats?
P: No, not really, just mostly chills.
D: OK, and how has your energy been the last few days, have you have you had a lot of fatigue?
P: Yeah, I just feel completely just sick like what it feels like I have the flu or something and I just feel really tired too.
D: OK, have you had a runny nose or sore throat?
P: No, not really. I did have like a I don't know if it was soreness, but just like a tickle in my throat just a few days back before the coughing started.
D: OK, yeah. And have you had any loss of smell or or loss of taste?
P: Yeah, now that I think of it, I I I I can't I can barely taste taste the food that I'm eating. I don't know about smell I I'm pretty stuff stuff stuffy right now so that might just be because of that. I definitely notice I can't really taste my food.
D: Alright. Uh, and uh, have you been having any wheezing?
P: No, no wheezing.
D: Alright, and shortness of breath, were you at rest when that that happened or were you exercising or exerting yourself? What, how did the shortness of breath come on?
P: I was actually just laying down and I was sleeping and I just noticed that I couldn't really take deep breaths, so I kind of just got back up and it was just during last night. It hasn't happened after that, but I'm scared it will happen again.
D: OK, and have you, how many pillows do you usually sleep with?
P: Just one.
D: Have you noticed any swelling in your feet or ankles?
P: No, nothing like that.
D: Alright, have you had any chest pain?
P: No, no chest pain.
D: Any feeling, any episodes where you feel like you were gonna faint?
P: No.
D: Feeling like your heart's racing?
P: No.
D: Alright, um, have you been having any abdominal pains?
P: No abdominal pains.
D: Alright, how about urinary problems?
P: No, nothing like that.
D: Any bowel problems like diarrhea?
P: No, it's pretty regular.
D: OK, have you noticed any rashes anywhere?
P: No.
D: Alright, and then how about like muscle aches or or joint aches?
P: No, nothing like that, just feeling tired.
D: OK and then have you had any changes to your vision?
P: No.
D: Like blurred vision or things like that?
P: No, nothing like that.
D: Any changes to your voice, like it sounds more hoarse to you or?
P: No, not really.
D: Oh, OK, and any nausea or vomiting?
P: I did feel a bit nauseous over the last two days, but I haven't vomited.
D: OK and have you been diagnosed with any medical conditions in the past?
P: No, I've been pretty lucky. No medical conditions. I don't even take any medications either.
D: OK, anything over the counter like supplements or herbal?
P: No, just just the cold medications over the counter, nothing else.
D: OK, any allergies to medications?
P: Not that I know.
D: Any hospitalizations?
P: No.
D: Have you had any prior surgeries?
P: Nope.
D: OK, um, and could you tell me a little bit about your living situation now?
P: Oh yeah, so I just live in a townhouse with my wife and two children. And yeah, currently, working as an engineer. Yeah, pretty everything else is pretty good.
D: OK, um have you had to miss work over the last few days?
P: Yeah, I actually didn't go to work yesterday, just felt terrible yesterday.
D: OK how have the wife and kids been feeling at home?
P: They're actually completely fine now. They don't seem to have any any symptoms of like coughing or anything like that.
D: Anybody at work that's been sick?
P: There was actually like just we work in the same kind of office setting. One of my coworkers was coughing just last week and like you know, my boss told us, told him to like, go home and get some rest and he was away for a couple days.
D: OK, uh, do you know what um what he had or anything like that?
P: No, I'm not really sure. Now that I think of it, like I I don't I haven't seen him since. Uh, so I haven't really asked him. Yeah, I'm not really sure.
D: OK. Has have you traveled anywhere, or has anybody in your office been been traveling anywhere?
P: No, not really. Not that I know, everything is pretty strict right now with with the pandemic going on.
D: OK. Um and yeah, do you smoke cigarettes?
P: No.
D: Do you drink alcohol?
P: Just rarely, maybe a couple times a month.
D: OK, do you use recreational drugs like IV drug use or opioids or crystal meth, anything like that?
P: No, nothing like that.
D: OK, and are you currently sexually active?
P: Yep.
D: OK, could you tell me a little bit about your your partner or partners?
P: Just my wife, no other sexual partners.
D: OK and have you had a sexually transmitted infection before?
P: Nope.
D: OK, and so in regards to your family history, has anybody had similar symptoms before?
P: No, not really. Not nothing like this.
D: OK, any heart attacks or strokes in the family?
P: No.
D: OK, and then how about so any cancers in the family?
P: I think I've had an aunt who had breast cancer but nothing else.
D: OK, um, so those are all the questions I wanted to go go through on history. I am concerned that you might might have COVID-19 or coronavirus. And so it could be COVID, or this could be another viral infection or possibly pneumonia going on. But it does sound like you have an infection and so we'll check some sputum cultures. And and we'll also do a PCR nasal swab testing for COVID. So we'll go ahead and order those tests and we'll see what their their results say.
P: Alright, sounds good. |
dataset\resampled_file\RES0184.wav | D: How may I help you?
P: Hi there, umm, so I've had this runny nose for the past five days and it doesn't seem to be going away so I thought I should get some help.
D: OK, and ah, with the runny nose, could you describe the discharge?
P: Yeah, it's, it's pretty clear.
D: OK, and have you had any nasal obstruction or feeling as though like one of your nostrils is plugged when you're breathing in?
P: Uh yeah, I have that feeling.
D: OK, have you had any pain on your face?
P: Pain? Ah no, nothing like that.
D: OK, how about a change to your sense of smell? Like loss of smell?
P: No, I haven't had that.
D: OK. Have you had any discharge from your eyes or eye redness or any eye pain?
P: No.
D: Alright, have you had a sore throat?
P: Uhm, no sore throat.
D: Have you had a cough?
P: No.
D: OK. Have you had any headaches?
P: Ah, just a slight headache.
D: OK, I mean, have you experienced headaches like this in the past?
P: Yeah, usually when I get sick, I get get a headache.
D: OK. OK, can you describe where you feel the headache the most and is it pulsating or kind of always there?
P: It's kind of always there and it's just on the sides of my head.
D: OK, have you tried anything for it?
P: Just some Tylenol, which seems to have helped.
D: OK. Uhm, and umm, yeah, have you had a cough?
P: Ah no cough like now, uhm, I I did have a slight cough last week.
D: OK, and it went away?
P: Mhmm.
D: Was it dry or did you were bringing up any sputum or phlegm?
P: No, it's pretty dry.
D: OK. Uhm, and do you have a sore throat?
P: No.
D: OK, and have you had any wheezing or shortness of breath?
P: No.
D: OK, and have you had any chest pain?
P: No.
D: How about any we, sorry, fainting or dizziness?
P: No, nothing like that.
D: OK, have you had any heart palpitations or feeling like your heart's racing?
P: No.
D: OK, uhm, and have you had any abdominal pain?
P: Uhm, I have had some, like diarrhea so I think part like my stomach hurt a little bit during that time, but I don't have that anymore.
D: OK, when did you have diarrhea?
P: Last week as well.
D: OK. Uh, was there any blood in the stool?
P: No.
D: OK, have you had any changes to your urinary habits? Like any pain or frequency?
P: No.
D: Alright, and have you had any nausea or vomiting?
P: No.
D: How about any fevers or chills?
P: Uh, no.
D: Have you had any night sweats?
P: Uh, no, nothing like that.
D: I see, OK. And have you had any weight loss recently?
P: No.
D: Alright, have you had any rashes or skin rashes?
P: No.
D: And how about any muscle aches or or body pains?
P: Oh, no.
D: Alright and how has your energy been? Have you had fatigue?
P: Uhm, a little bit.
D: OK, little fatigue and and how has your appetite been?
P: Appetite's been OK, I'm still eating.
D: Alright. And, uhm have you been diagnosed with any medical conditions before?
P: Uh, no, I've been pretty healthy.
D: OK, great and so do you take any medications regularly, either over the counter or prescribed?
P: No.
D: OK, and do you have any allergies?
P: No, I don't.
D: OK, and any recent hospitalizations in the past or any prior surgeries?
P: Uh, no. Actually, I had my appendix taken out when I was younger, but that was a long time ago.
D: OK, I see. And are you living, ah, can you tell me about where you're living now and who you're living with?
P: I'm I'm living by myself. I'm a student. I live in an apartment.
D: OK, and are you going to classes in person right now?
P: No, they're all online.
D: OK. And have, have you been around anybody who's been sick?
P: No, not that I can think of.
D: OK, and have you traveled anywhere recently?
P: No.
D: OK. And you smoke cigarettes?
P: I don't.
D: And do you smoke cannabis or use any cannabis products?
P: Occasionally, I will.
D: OK, how often?
P: Uhm I will maybe smoke once a week.
D: OK, uh, and use any recreational drugs like cocaine or opioids?
P: Oh gosh, no.
D: And do you drink alcohol?
P: Uh yeah, occasionally.
D: OK, how many drinks would you say you have per week?
P: Uhm, I'll have like a bottle of wine a week.
D: OK, and are there any heart or lung conditions that run in the family?
P: No.
D: OK. How about any cancers?
P: I think like colon cancer runs in the family.
D: OK, umm and alright so that was everything that I think I wanted to ask about on that on the history today. I was wondering if there was anything else that you wanted to mention that I maybe forgot to ask about?
P: No, nothing else I I I was just wondering what I could do to feel better or make this go away.
D: Yeah, certainly. So, I, so it's sounds like you have the common cold or a viral illness, which it could be caused by something like adenovirus or there are others as well. However, the symptoms do overlap with COVID. As you can be like nonspecific symptoms, such as having kind of just like a runny nose like you do here, and so we will do a COVID swab and we'll await those results, but in the meantime it's mostly supportive care, so it means just trying to stay hydrated, stay rested. And just monitor your symptoms because if things do get worse, it'll be important to, uh, go to the emergency room.
P: OK.
D: Alright, so we'll get the swab now and get that testing started.
P: OK, that sounds great, thank you.
D: Alright, thank you. |
dataset\resampled_file\RES0130.wav | 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. |
dataset\resampled_file\RES0166.wav | D: What brings you in here today?
P: I've just been feeling really short of breath since this morning, and I don't, uh yeah I don't know what's going on.
D: It just started this morning.
P: Yeah.
D: And uh, did you wake up feeling short of breath or was it after you had woken up and we were doing activities?
P: It was when I was doing activities.
D: OK, and what were you doing before you had the shortness of breath?
P: Oh, I was just going to the kitchen to make breakfast.
D: OK, and uhm can you describe the shortness of breath? Is it more so that you're having trouble, deep breaths, or are you taking shallow fast breaths? How would you describe it?
P: Uhm? I guess just shallow, fast breaths, I feel like I've run a marathon and I just yeah and all I've done is just walked to the kitchen.
D: OK and has this happened to you before ever?
P: No.
D: No? OK. Are you having any other symptoms like off sore throat, chest pain, anything like that?
P: No.
D: So it's just the shortness of breath.
P: Yeah, that's it.
D: OK. And so it it started this morning, is it still continuing, or is it, uh?
P: Still there.
D: OK, is it worse at all than it was this morning?
P: Uhm, kind of the same, I'd say.
D: OK, are you getting any kind of chest discomfort or anything at all with breathing?
P: Maybe when I take a very deep breath, then yeah. It just kind of I feel like this sharp pain.
D: OK. How have you, having I've been having any chills or fever or anything like that?
P: No.
D: OK, any dizziness or fainting spells?
P: No.
D: OK, do you feel that your heart is racing at all?
P: No.
D: OK, And, and have you tried anything that's helped you improve those symptoms, like taking a rest or laying down flat? Anything like that?
P: No, haven't really tried much. It just started this morning so I I just decided come in. Right away.
D: Ok. Have you traveled at all recently?
P: Um, no.
D: Any uh contacted someone who's been sick recently?
P: I don't think so.
D: OK.
P: I did just say sorry, I I did just get out of the hospital so maybe I could have had some contact. There's some exposure there.
D: OK, so so when did you get out of the hospital?
P: Uhm, two days ago.
D: Two days ago, OK, and what were you in the hospital for?
P: Uhm? I had, I broke my hip.
D: OK, and did you have a surgery for your hip?
P: No. They didn't think it was, surgery was needed.
D: OK, so how long were you in the hospital for?
P: About 4 days.
D: Four days, OK. And in those four days what were they doing for you there?
P: Just trying to help me just doing physiotherapy and helping me sort of get up and get out of bed.
D: OK.
P: And like giving me pain medications.
D: And since, or like when you went home today, set up any kind of home care for you or anything like that?
P: Yeah they did. A nurse comes in once a day.
D: OK, and how about uh physiotherapy?
P: Yeah, I don't know. They haven't really been coming in and I I asked the nurse and she said she's gonna look into it. Maybe something went wrong there.
D: OK, Um, and after you've been discharged, have you been moving around at all, or if you've been pretty immobilized?
P: I try, but it's been it's been hard like, specially the first couple of days. I don't think it did much. But since then, I've been, I've been trying to move around a little bit more.
D: OK. Have you noticed any kind of swelling in your legs at all?
P: Uh, no.
D: No, nothing like that?
P: No.
D: Have you previously had any kind of clots, like a deep vein thrombosis or pulmonary embolism? Anything like that?
P: No.
D: Have you had any previous diagnosis of cancer?
P: I did in the past. About 10 years ago I had leukaemia.
D: Leukaemia, OK. And are you still on any kind of treatment or do you see an oncologist or a mythologist?
P: No, not anymore.
D: Not anymore? OK. Um and so are you experiencing any kind of coughing up blood or anything like that?
P: Uhm, no.
D: No. OK. Um do you feel any pain in your caps at all?
P: No.
D: No, OK. Alright, other than that, are you having any symptoms of nausea and vomiting at all?
P: Uhm, no I don't.
D: OK, any fevers or chills?
P: No.
D: OK. Any night sweats or fatigue?
P: No.
D: Ok. Any diarrhea or constipation?
P: No. None of those.
D: OK. And besides the cancer, any previous medical conditions that you've been diagnosed with?
P: No, I was pretty healthy before that.
D: Ok, any history of any clotting or clotting disorders at all?
P: No.
D: OK. Do you take any medications currently?
P: No, no, not anymore.
D: OK, any allergies to any medications?
P: Uhm, no.
D: Ok. Um any family history of any lung or heart conditions?
P: Um, no lung or heart conditions, no.
D: OK. And currently right now do you work at all?
P: Yeah I do. I um, I'm a banker.
D: Banker OK. Uhm. And what's your living situation like? Where do you live with anyone or inward? Where do you live?
P: I live at home with my husband and my two kids.
D: Ok, and you smoke it all?
P: No, I don't.
D: OK. And do you use any recreational drugs like marijuana?
P: Uh, sometimes I'll have marijuana with my friends, but I haven't really done that since the pandemic started.
D: OK, and you drink alcohol?
P: Yeah, I do come. I'll have maybe two or three glasses of beer on the weekend.
D: OK. Alright, so these are all this questions I had for you today. We'll do a full physical examination next. Do you have any questions or concerns?
P: No.
D: OK, so yeah, right now one of the main things we want to rule out, especially since you had the sudden shortness of breath today after a history of just recent discharge and the hip fracture or injury, and you're immobilized we need to make sure you haven't developed a clot that has traveled to your lungs. So we'll do a full physical examination and get some blood work done initially and then see if you require any medications for if you need thrombolysis for to break up the clot. We'll, we might do some imaging as well, so yeah, well, we'll just start with that, and then we'll go from there.
P: Sure.
D: So you'll be in here for a few hours until we get all those things done and see if you need any admission at all to the hospital.
P: Sure.
D: Alright.
P: Thank you.
D: Welcome, take care. |
dataset\resampled_file\RES0163.wav | D: What brings you in here today?
P: Hey, I just, um, I just kind of came in to talk about my stuffy nose. It's yeah, it's been a problem for, I don't even know how many years it's always been there. And now that school is a little less busy and things are virtual and have more time, I decided I'll get something done, um, to get it fixed.
D: OK, and how long has this been going on for?
P: Since I was young, um like maybe years, couple years.
D: OK, and then do you like how often are you getting the stuffiness? Is it like every day? Is it during the day at night? When do you usually get it?
P: It's kind of uhm, it's kind of all the time, to the point that I've somewhat gotten used to it. And it's just my, it's only on the left side and it's just always kind of stuffy. Initially I would have trouble falling asleep 'cause it would, I would just find it a little bit bothersome, but now I'm kind of just used to it.
D: OK, and so it's just on the left side. It never moves to the right side.
P: Well, like sometimes when I get ill its on both sides, but usually it's on the left side.
D: OK, and so you have stuffiness. But do you ever get any kind of discharge or drainage from your nose?
P: Sometimes I get a little bit bleeding.
D: Are you, OK. Um, bleeding? Is it blood mixed into the discharge or drainage? Or is it like you get nosebleeds?
P: I get nosebleeds like maybe yeah. Like maybe when I'm exercising or something I'm like at the gym. Uhm, fom doing the gym class. Yeah, yeah when playing with my friends.
D: OK, and how often do you get these nose bleeds?
P: Uhm? Maybe once a month or once in two months.
D: OK. And umm, and is there any, do you have any other symptoms? So like, do you have any pressure, sensation in your face around your jaw, cheeks, forehead?
P: No.
D: No, so OK. And do you find yourself having more congestion when you wake up?
P: Uhm? Not really, maybe a little bit.
D: OK, so it's not worse when you're lying flat or anything like that?
P: No.
D: OK, um, and do you find that you have to constantly clear your throat at all throughout the day?
P: Uhm, no.
D: OK, and do you at all feel that some stuffiness drains back into your throat at all anytime during the day?
P: I don't think so, no.
D: So it's just the congestion that's been going on for quite some time and does it change with the seasons at all?
P: No, it's just there all the time. Like I can't even tell. This is like my normal now, but my mom said I should get it checked out.
D: OK, uhm. Have you tried anything for it like either medications or the neti pot or steaming and has anything helped you at all?
P: I tried steaming but it didn't do much. It kind of got better. Maybe for an hour maybe, but then yeah, it didn't do much.
D: OK, and otherwise, are you having any other symptoms like fever, chills, cough, sore throat, anything like that?
P: No.
D: Are you having any loss of sense of taste or smell?
P: Uhm, no.
D: Any shortness of breath at all?
P: No.
D: OK, uh. And otherwise, any recent travel or in contact with anyone who's been sick?
P: Uhm, no.
D: Have you previously been diagnosed with any medical conditions?
P: No, I'm pretty healthy.
D: And do you know if you have any allergies to any medication?
P: Uhm, no, no allergies to medications.
D: OK, and any allergies to any environmental issues like factors that cause more stuffiness, sneezing, itching, red eyes, runny nose anything like.
P: I'm allergic to cats.
D: Cats? OK.
P: But I haven't been around one for awhile.
D: OK, uh, anything else like in your house or environment like carpets, dust, like anything that might irritate, give me more irritation?
P: No, not really.
D: OK. So it's just a cat that you know, but you haven't been around. Do you have any other animals at home?
P: Uh no, I don't.
D: No OK. Do you have any headaches at all?
P: No.
D: Any changes in your bowel movements?
P: No.
D: Any urinary problems?
P: Nope.
D: Has this affected your sleep or appetite?
P: I snore at night sometimes, but that's, that's about it.
D: OK, and do you snore, would you say most nights or is that something like has someone told you that?
P: My mom told me and sometimes I, I sleep with my mouth open.
D: I see, OK. And do you know how long you've been doing this for?
P: Uhm, again, it's been like months or years.
D: OK. And do you ever get, do you ever wake up at night trying to take a breath like just gasping for air?
P: No.
D: OK. Have you ever had any surgeries or hospitalizations before?
P: No.
D: Yeah, OK. On any family history of any heart or lung conditions.
P: Uhm, just heart disease.
D: OK, then who has it? Or who had it?
P: My my dad. My dad has, had a heart attack and my mom has high blood pressure.
D: OK. And how old was your dad when he had a heart attack?
P: He was 50 years old.
D: 50 years old? Ok. And I'm currently right now, uh, are you a student? Do you work?
P: I'm a student.
D: And what's your living situation like?
P: I live with my parents.
D: Ok. And do you smoke at all?
P: No.
D: OK, have you ever smoked?
P: No no no.
D: Uh, any, any recreational drugs like marijuana?
P: Oh God no, never.
D: No? Ok. And do you drink alcohol?
P: No.
D: OK, and how, how's your home environment? Do you generally feel safe in your home environment as well as outside of your home?
P: Oh yeah, it's great.
D: Ok. So yeah, so mainly yeah. So there's all the questions I had for you. Do you have any questions or concern?
P: Nope.
D: Ok so there can be many different reasons for this chronic congestion and we'll do a full physical examination for you today. Uh and some of the possible things that can be happening is you might be having a sinus issue like a chronic sinusitis. You can be having an allergic rhinitis or with the snoring and just the chronic congestion. You may be also having something called obstruct, obstructive sleep apnea. And there can be structures in your mouth, throats that can cause you to kind of obstruct and snore at night as well, and that even the congestion might cause that as well. So yeah, we'll do a couple test first and then if required, we might need to do some imaging and even perhaps send you to an EMT specialist if we think it's obstructive sleep apnea there. For now, we'll just do the physical examination to go from there.
P: Great, thank you.
D: Welcome, take care. |
dataset\resampled_file\RES0037.wav | D: I would just like to start with what brought you in here today to the family clinic?
P: Yeah, so I've been coughing for a few months now and so that's the problem.
D: OK, and how many months have you been coughing for?
P: Just over two, I would say, and it's been I've been bringing up this yellow, greenish sputum. It's kind of gross.
D: OK, and how, how much of the sputum would you say you're bringing up in an average day? Like a teaspoon? Tablespoon?
P: : Oh I see OK. I don't know, maybe a few teaspoons throughout the day.
D: OK.
P: At first I thought I I I had a, a chest infection, but even after antibiotics from my GP, or or my family doctor, It never cleared up.
D: OK, and so when did you go on the antibiotics?
P: Ah so this is about, uh, about a month ago.
D: Mhmm.
P: And yeah, so I went to see my family doctor about the cough then and dad was prescribed some antibiotics. I think azithromycin and it, it still didn't, it didn't do anything.
D: OK, I see. And do you find that your cough has been getting worse since then?
P: Uh, I would say the cough has been about the same.
D: OK. But how about the sputum that you're bringing up, has that increased?
P: Uh, it's about the same, but it definitely I would say there's a pink tinge in the sputum now. Every once in awhile I've noticed more than than before.
D: OK. And did this all start after the chest infection or did you have something like this occur before?
P: Um, yeah, this all started after.
D: OK, I see. Was there anything that happened around that time? Any new environment that you were exposed to?
P: Ah, well, I did go to India a few months ago.
D: OK, and how many months was that? Was that also like two months ago?
P: Yeah, about that, probably closer to three or four, but yeah, right around the time that that I think this, uhm cough started or just before I got back.
D: OK, I see. And how often are you coughing in a day?
P: Ah. a few times an hour.
D: OK. Anything that makes your cough go away now you've tried?
P: Uh, no nothings really helped it go away.
D: OK, and is it better or worse? During good morning as opposed to night?
P: Uh, it's pretty, it's pretty bad all day actually and it's been impacting my sleep because I've been coughing at night too.
D: I see. And, um, in terms of things that make it worse, anything you do around the house or at work that makes the coughing worse?
P: Uh yeah, I guess if I'm just moving around a little bit more it might bring it on a little bit more, but it's pretty bad all day.
D: I see. And in terms of any other symptoms you might be having, uh, do you have any shortness of breath, runny nose, any chest pain?
P: Um, no, not really.
D: OK. Besides the pain tinged sputum, have you ever coughed up blood, like red blood?
P: Not anything that was really bright red. More pink.
D: More pink. OK. Yeah, so you traveled to India just two months ago. Do you remember what kind of place you stayed in India? Was it a, a in a crowded place or were you by yourself?
P: Well, I mean there is a lot of people around. Yeah, there was not a lot of room where I was was staying, so it was pretty crowded.
D: OK, and was there anyone that was ill around you or any exposure to tuberculosis?
P: Uhm, not that I'm not aware of. I was around my family but, umm, I guess it's possible.
D: OK. And once you came back did anyone else, in your family get sick? Or was it just you?
P: Oh yeah, I spoke to my relative went when I got back and they they didn't tell me about one of my cousins there that was feeling sick.
D: OK. And have you been having any fevers or chills?
P: Yeah, I feel I feel like I've been pretty pretty hot sometimes.
D: OK, and how about night sweats?
P: Yeah, the coughs been messing with my sleep, and I've been waking up with night sweats.
D: OK. And have you been having any headaches?
P: Ah no headaches.
D: Any do you feel that you've lost any weight recently?
P: Uh, maybe a few pounds, but um.
D: Have you tried to lose weight, or was that unintentional?
P: No, I, I was kind of surprised. I thought I would have gained weight 'cause I've been a bit more lazy recently, but the weight seems to be down anyway.
D: I see, OK. Have you noticed any wheezing sounds when you breathe out, or breathe in?
P: No wheezing.
D: OK. And you mentioned no chest pain, right?
P: Yeah, no chest pain.
D: OK, have you noticed any kind of swelling in your legs or hands or anywhere else in your body?
P: No swelling.
D: OK. Any bowel movement changes, any constipation or diarrhea? Any of those?
P: No.
D: OK, any urinary problems?
P: Uh, no.
D: OK, any changes in your appetite at all? Do you feel that you've lost any appetite?
P: Um yeah, yeah maybe eating a little bit less.
D: OK. And in your current environment right now, are you exposed to any fumes or dust or any animals?
P: Uhm, we have a dog, but um, no fumes or anything like anything like that.
D: OK, have you experienced any kind of dizziness or fainting spells?
P: No.
D: OK. In terms of your past medical history, have you been diagnosed with any medical conditions?
P: Um, yeah I meant, uh, high blood pressure. Type 2 diabetes and high cholesterol.
D: I see. And are you taking any medications for any of those?
P: Yeah, I'm taking uhm, a few medications for blood pressure and uh, and and diabetes right now, and I think I Rosuvastatin for for the cholesterol. I'm not sure of the other ones though.
D: OK, no worries. And do you know if you're allergic to any medications or do you have any environmental allergies?
P: I think I I got a rash to penicillin when I was when I was younger, but that's it.
D: OK, any previous hospitalizations?
P: Uh, nope.
D: OK, any surgeries?
P: No surgeries.
D: OK, and in your family has anyone ever had any cancers or died of a heart attack?
P: Yeah, my mother out a heart attack when she was 48.
D: OK. And has anyone ever had anything like pulmonary fibrosis or any autoimmune conditions?
P: Uhm. What are those?
D: So pulmonary fibrosis is a condition in your lung where you start getting like these nodules.
P: I see.
D: And it can run in the family and that can cause some of the symptoms like a chronic cough. It can cause sometimes shortness of breath and it can sometimes be associated with the like some connective tissue disorders that can run in the family. Umm, any of those ring a bell?
P: No, I haven't heard of anything like that in my family.
D: OK. Yeah, and other than that, where do you currently live? Do you live by yourself or with anyone else?
P: Yeah, I live with my husband and three sons just outside of town here.
D: OK. And have any of them been sick?
P: No, everybody's been feeling well at home.
D: OK. And do you work currently?
P: Uh, no, I'm I retired.
D: OK. And currently do you smoke? Cigarettes?
P: Yeah yeah, I smoke about a half a pack of cigarettes per day and ah, I've been trying to cut down.
D: OK, and how long have you been smoking for?
P: Ah probably like 30 years.
D: I see and do you use any recreational drugs like marijuana or cocaine?
P: Ah, no I've never used anything like that.
D: OK, and how about alcohol? Do you drink alcohol?
P: Uhm, no.
D: No, OK. Alright, so yeah those are all the questions I had for you today. Do you have any questions for me or any questions or concerns?
P: Um, not right now.
D: OK, so we'll be doing some investigations since you recently traveled to India, we need to make sure that you don't have tuberculosis, as that's prevalent in some parts of India. So we will do some, we might get like a chest X-Ray for that, you may have a pneumonia as well and then we'll go from there. Does that sound good?
P: Yeah, for sure.
D: OK alright well, yeah, well, after those tests have come back, we'll see you in the next appointment for follow up.
P: Thank you.
D: You're welcome. |
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