Upload 3 files

CAR0003.txt

@@ -0,0 +1,245 @@
+D: What brings you in here today?
+
+P: Yeah, I've just been feeling breathless and it's getting worse. So I wanted to check it out.
+
+D: OK, and when did you first start feeling breathless?
+
+P: About two months ago.
+
+D: OK, and did it come on about like gradually through time or suddenly just happened?
+
+P: I guess gradually, yeah.
+
+D: OK. And, do you feel, uh, how often do you feel breathless?
+
+P: I'd say it's worse when I when I walk more than 50 meters. That's kind of the main like that's kind of the main trigger, just exertion.
+
+D: OK, and were you able to walk normally more than 50 meters before two months?
+
+P: Yeah, three months ago I was fine.
+
+D: OK. And do you have any other symptoms like cough or chest pain?
+
+P: I have a cough sometimes, yeah.
+
+D: OK, but nothing like constant? 
+
+P: No.
+
+D: OK, and do you have any wet cough or any productive cough or are you producing like sputum or phlegm?
+
+P: Yeah, I guess I'd say I have this frothy sputum.
+
+D: OK, and has your breathlessness been getting any worse at all over the last two months?
+
+P: I would say so, yes.
+
+D: OK, and you mentioned like exertion makes it worse, but anything else like going outside or exposure to any chemicals that makes it worse?
+
+P: Uh, I don't think so.
+
+D: OK, and how about a positional changes? Does lying flat at all make it worse?
+
+P: I would say so, yes. Yeah, I'm basically gasping for air when I lay down.
+
+D: OK, and do you ever find yourself waking up at night in the middle of the night to catch your breath?
+
+P: No.
+
+D: No, OK. And when do you feel the breathlessness the most? Is it more so during the day or at night?
+
+P: I guess it's worse at night because I'm laying down. 
+
+D: OK. Great and, in terms of how many flights of stairs you can climb before you start feeling breathless, do you have a number? 
+
+P: I would say like 3/4.
+
+D: Three or four steps, OK. And was there anything new that happened in your life recently? Any new medical diagnosis recently? Or any travel that happened before you started having these symptoms?
+
+P: No, nothing like that.
+
+D: OK, and prior to two months, have you ever had any similar experiences?
+
+P: Prior to 2 months? No. 
+
+D: OK. And, does anything make it better? Like any positional changes makes the breathlessness go away?
+
+P: I guess when I I'm not laying down or when I'm laying down, I try to add pillows, stack pillows so that it gets better. 
+
+D: OK, and are you having any other symptoms like sore throat, runny nose, chest pain, dizziness, anything like that? 
+
+P: No. 
+
+D: OK. Have you recently traveled outside of the country?
+
+P: No.
+
+D: Have you recently had any surgeries?
+
+P: No recent surgeries, no.
+
+D: OK, any headache nausea or vomiting? 
+
+P: Um, no.
+
+D: OK, any fevers or chills or night sweats.
+
+P: No. 
+
+D: OK. Do you feel increasingly fatigued throughout the day?
+
+P: Uh, I would say so, yeah. 
+
+D: OK. And any changes in your bowel movements at all?
+
+P: No.
+
+D: OK, and any chest pain at all within the last two months?
+
+P: No, no chest pain. 
+
+D: OK. Any swelling in your in your legs, ankles, or in your hands and arms?
+
+P: There is some swelling.
+
+D: OK, and uh, where do you, where are you getting this swelling?
+
+P: Around my legs.
+
+D: OK, and how when did you first notice this?
+
+P: Around the same time actually two months ago.
+
+D: OK. Have you noticed any kind of fevers at all? 
+
+P: No.
+
+D: OK. Have you been in contact with anyone that has been ill recently?
+
+P: No no. 
+
+D: OK, and have you been coughing up any blood at all?
+
+P: No. 
+
+D: OK, any weight loss? 
+
+P: No.
+
+D: Any night sweats or chills?
+
+P: No. 
+
+D: OK, apart from the breathlessness when laying down, any other issues with your sleep?
+
+P: No. 
+
+D: Any changes in your appetite?
+
+P: Nope. 
+
+D: OK, have you had any recent infections like a cold at all? 
+
+P: No. 
+
+D: OK, any exposure to tuberculosis in the past?
+
+P: Not that I know of. 
+
+D: OK, any exposure to fumes or dust within your home or work environment?
+
+P: No.
+
+D: OK, any animals or pets in the house?
+
+P: No, no.
+
+D: OK, and in terms of your past medical history, has anyone told you that you have anything like COPD or any cardiovascular issues like high blood pressure, cholesterol?
+
+P: Um so, yeah, so I have high blood pressure, diabetes and high cholesterol. 
+
+D: OK, and do you take any medications for this?
+
+P: Yep, so I take aspirin, ramipril and simvastatin.
+
+D: OK, and have you ever had any chest pain or heart attack in the past?
+
+P: Yeah, actually I had a heart attack four years ago.
+
+D: OK, and do you remember what they did for your heart attack?
+
+P: Something like a stent or something.
+
+D: OK, and since then you've been on these medications?
+
+P: Yes. 
+
+D: OK, and after they managed your heart attack, have you ever had similar symptoms to when you had your heart attack?
+
+P: No, no.
+
+D: nothing like that? OK. Do you have any allergies to any medications?
+
+P: No.
+
+D: Any environmental allergies?
+
+P: No.
+
+D: OK, and have you previously had any surgeries in the past?
+
+P: Um, I guess the stenting. 
+
+D: Just the stenting? And apart from that, have you had any other previous hospitalizations?
+
+P: No.
+
+D: OK, and any family history of any cancers or heart attacks?
+
+P: Um, my father died of a heart attack when he was 60. 
+
+D: OK. And currently do you work at all?
+
+P: I do, um, I work as a cashier.
+
+D: OK. And has the shortness of breath been affecting your daily routine at home or at work at all?
+
+P: Yeah, I would say so. It's been hard to make it to work and then standing around all day or if I have to go help out with something and exert myself too much, I get short of breath. 
+
+D: OK. And at home, do you currently live with anyone or do you live by yourself?
+
+P: I live by myself. 
+
+D: OK, and do you live in an apartment or house?
+
+P: I live in an apartment.
+
+D: OK, and are there any exposures like dust or mold or asbestos in your home environment? 
+
+P: No.
+
+D: OK. And currently do you smoke?
+
+P: Not right now. I used to smoke. I used to smoke 10 a day for like 40 years. 
+
+D: OK, and do you use any recreational drugs like marijuana? 
+
+P: No.
+
+D: OK. Any alcohol?
+
+P: No. 
+
+D: OK. And in terms of your daily routine, do you feel that you get 3 meals a day, a well balanced diet?
+
+P: I wouldn't say well balanced. I'm trying to eat healthier but doesn't always happen.
+
+D: OK, and how about exercise? Do you find that your exercise levels or activity levels have gone down in the last two months?
+
+P: Yes. 
+
+D: OK. Alright, is there any other questions or concerns that you have or something I may have missed to ask you today?
+
+P: No, I don't think so. 
+
+D: OK, so based on what we talked about from your swelling as well as breathlessness while laying down and your past history of a heart attack and high cholesterol, it may be likely with the medications you are on as well as your history, that you might be having what's called congestive heart failure. So we will need to do further investigations to determine if that is what it is and if we need to get you on something like lasix or a diuretic to get rid of some of the fluid that's building up in your body, which may be caused by heart failure. So we'll do some investigations and then go from there.

CAR0004.txt

@@ -0,0 +1,137 @@
+D: What brings you here today?
+
+P: I'm just having this really sharp pain in my chest and I'm scared. I think I'm having a heart attack.
+
+D: Oh wow, yeah um that must be really scary. When did this, when did this pain start?
+
+P: So about 3 days ago.
+
+D: Three days ago, OK, and where exactly in your chest do you feel it?
+
+P: It's kind of right here, right over my heart I think, that's where it's the worst. 
+
+D: OK, and is it, what kind of pain is it? Is it more like a dull pressure pain, or is it a sharp pain? How would you describe it?
+
+P: I would say it's a sharp pain.
+
+D: A sharp pain, OK. Um, so it started three days ago, has it been coming and going or has it been constant?
+
+P: It just lasts for a few seconds and then it goes away.
+
+D: OK, does the pain come on when you're doing any activities or When does the pain usually come on?
+
+P: Oh, it's usually worse when I'm coughing or laying down. Yeah, yeah. 
+
+D: OK, and um, does it improve with any positional changes at all, or anything that you do that does it help?
+
+P: When I when I lean forward, it actually does get better. I think about it, yeah.
+
+D: OK, and has this ever happened to you before?
+
+P: No, no it hasn't.
+
+D: OK and on a scale of 1 to 10, one being the least amount of pain felt and 10 being the worst, how much would you rate it? 
+
+P: I would say a 6 out of 10.
+
+D: OK, and does the pain move anywhere in your chest or does it stay in the same spot?
+
+P: Yeah, I think it kind of goes to my neck sometimes.
+
+D: OK, and do you have any other symptoms, like do you have any shortness of breath, dizziness, anything like that? 
+
+P: No, I don't.
+
+D: OK any any palpitations?
+
+P: No.
+
+D: OK. Alright, and other than that, have you been having any other symptoms at all besides the pain?
+
+P: No, no, nothing else, that's it, just have these sharp episodes of pain that last a couple of seconds.
+
+D: OK, um have you have you tried like any medications that has helped the pain?
+
+P: Yeah, I took some um, I took some Tylenol and that did help.
+
+D: OK.
+
+P: I took it once yesterday.
+
+D: Alright, um, any recent injuries to the area like did you have any falls or anything like that?
+
+P: No, no I haven't.
+
+D: Any headaches, nausea or vomiting, fevers, or chills? Any of those symptoms?
+
+P: No. 
+
+D: OK, any cough, runny nose, any viral symptoms?
+
+P: No, well not right now, but I did have a, I did have a flu last week. I had a fever, had a runny nose. I did have a bit of a cough and I was feeling super tired, but not anymore. I'm OK now.
+
+D: OK, and have you at all had any dizziness or have you fainted at all?
+
+P: No.
+
+D: OK. Have you been noticing any kind of weakness or numbness?
+
+P: No.
+
+D: No, OK, and in terms of your past medical history, do you have any medical conditions like diabetes, high blood pressure, any other diagnosis?
+
+P: No. I'm a pretty healthy 25 year old.
+
+D: OK. Um, do you take any medications?
+
+P: I sometimes take Tylenol.
+
+D: OK, and any allergies at all?
+
+P: No. 
+
+D: OK, and any previous surgeries?
+
+P: No no, no surgeries.
+
+D: Do you have any family history of any heart conditions or any cancers or anything like that?
+
+P: Yeah, my father, he he had a heart attack two weeks ago and he and he passed away. And I'm worried I am having a heart attack too. 
+
+D: It was just two weeks ago?
+
+P: Yeah.
+
+D: I'm so sorry to hear that. Yeah, it must be really difficult time for you right now. OK, so you're worried you might be having a heart attack as well? 
+
+P: Yeah.
+
+D: OK, so we can definitely do some tests and see what was going on. I just have a few more questions and then I'll just get to some of the management and what we will be doing for you in the future. So currently right now do you work at all?
+
+P: No, I'm a student. I, well as a part time job, I do work as a post man.
+
+D: OK, and where are you a student? What do you do?
+
+P: I'm studying engineering at Western. 
+
+D: Alright, and currently where do you live? Do you live in student housing, an apartment or a house?
+
+P: I live with my parents, well my mom now, in a house.
+
+D: Right, and you drink at all any alcohol? 
+
+P: I drink occasionally, maybe one or two drinks on the weekends.
+
+D: OK, and any recreational drug use like marijuana or cocaine?
+
+P: No. 
+
+D: And do you smoke?
+
+P: No.
+
+D: Alright, so those are all the questions we had for you today. And yeah, it must be really difficult and scary for you right now, but we'll make sure to get to the bottom of this to see what's going on. So what we can do is get you an ECG to see how your heart is functioning and then see getting the blood work if we need it for the future. But yeah, right now I would say try not to worry too much about it right now and see um what some of those tests come back.
+
+P: Thank you. 
+
+D: So yeah, you're welcome.

CAR0005.txt

@@ -0,0 +1,133 @@
+D: It sounds like that you're experiencing some chest pain.
+
+P: Yeah, so this chest pain has just been coming on for the last couple of weeks now.
+
+D: OK, uhm. So 2 weeks, and can you tell me kind of where you're feeling that pain? 
+
+P: Um yeah, I'm I'm just feeling this chest discomfort, sort of over on the left side.
+
+D: The left side, OK. Does does it stay just in one spot or does it kind of spread anywhere else?
+
+P: No, I don't really feel it anywhere else. Yeah, I just feel it in that one spot on the left side. 
+
+D: OK, does it feel dull and achy, or does it feel more sharp?
+
+P: It feels pretty sharp. 
+
+D: OK, and is it constant like on all the time, or do you feel like it kind of comes and goes? 
+
+P: It comes and goes. I would say I it might last for um 20-30 minutes at a time and then it goes away.
+
+D: OK, and over the last two weeks since you said it started, has it gotten any worse?
+
+P: Uh, no. It's been about the same.
+
+D: About the same, OK, and has it gotten more frequent, these like 20 to 30 minute episodes?
+
+P: No, it's happened about two or three times during the 2 weeks.
+
+D: And if you were to rate it on a scale of zero to 10, zero being no pain and 10 being like the worst pain you've ever felt, where would it fall?
+
+P: I would say a 4 out of 10. 
+
+D: OK. Uh, can you think of anything that that you've done differently recently that could have brought it on or is there any kind of common factor between the times that you had the pain?
+
+P: Um,  I don't know I've separated from my husband 2 two years ago which has been really stressful but other than that I mean I can't really think of any changes to my health or anything like that recently.
+
+D: OK, but do you feel like you have been more stressed out in general?
+
+P: Uh, yeah the last couple of years have been a lot more stressful because of those issues in my personal life.
+
+D: OK, I'm sorry to hear that, but I'm glad that you're coming in and we can hopefully get to the bottom of this. Not that I think that's necessarily the source of your pain, and we definitely want to look into everything, but it is really helpful to know that. So when you've had these episodes, have you taken anything to help with the pain or done anything that's that you felt it made it go away?
+
+P: Uhm, I've tried some Advil, some Tylenol and actually some Tums as well, and it hasn't really helped.
+
+D: OK, do you think it's worse when you're moving around, if you're if you're kind of doing more exercise, or is it kind of just the same no matter what you're doing when you get the episodes?
+
+P: Oh, it actually I I feel like it happens most of the time when I'm either at work or or driving. 
+
+D: OK. OK, and before this two week period, have you ever had anything like this before?
+
+P: No, I haven't had anything like this happen before.
+
+D: Do you have any chronic conditions that you see your family doctor for?
+
+P: No, previously healthy.
+
+D: And just jumping back to these pain episodes when you have them, do you experience anything else? Do you get any nausea or vomiting?
+
+P: No. 
+
+D: OK, do you get any, do you have any difficulty breathing during these times?
+
+P: No, I haven't. 
+
+D: OK, and have you noticed any fevers?
+
+P: Uh, no, no fevers.
+
+D: OK, have you been in contact with anyone that's been sick recently?
+
+P: Uhm, no, I haven't.
+
+D: And have you traveled anywhere outside of Canada?
+
+P: No, I've been home.
+
+D: OK so you have, you said you have been previously healthy, nothing that you've been seeing your family doctor for on a regular basis. Do you take any medications?
+
+P: Uhm, I do not, no medications, just the Tylenol and Advil I tried for the pain.
+
+D: OK, do you have any allergies?
+
+P: No allergies.
+
+D: And is there any history of heart problems in your family?
+
+P: Yeah, my father had a heart attack when he was 60 just last year and it's actually one of the reasons what concerns me about the chest pain that I thought I was having.
+
+D: For sure, it always feels very concerning when when you have these these symptoms and that and you know people in your life that have had issues like similar issues in the past. I don't know that this is related to that. I I personally don't think so at this point, but we're definitely going to do everything to look into it and and rule out something that would be scary like that. I'm going to ask you few more questions about your lifestyle in general. Do you smoke cigarettes?
+
+P: Yeah, I smoke about half a pack to a pack per day. I've been trying to quit and I was smoking more one pack per day, but so it is down a little bit, but, It's still something I'm trying to work on.
+
+D: Congratulations, that's a really tough thing to do so, good for you. That's that's really exciting. Step in the right direction, right? Do you drink alcohol?
+
+P: Um, I do, but, uh, I'll have maybe one or two glasses of wine on the weekend.
+
+D: Do you use any other substances? 
+
+P: Uh no.
+
+D: I know that you said you don't see your family doctor for anything regularly, but I just want to check a couple of specific things like have you ever been told you have high blood pressure?
+
+P: No, I've never been told I've I've had high blood pressure.
+
+D: And have you ever been told you have like high cholesterol?
+
+P: I haven't, but I've actually never been tested either.
+
+D: OK, and do you exercise regularly?
+
+P: Yeah, actually, I'll either do some running or cycling, probably three or four days per week and I haven't had any chest pain or or problems exercising.
+
+D: OK, that's good to hear. And have you ever had problems with heartburn? 
+
+P: Uh. I don't think so, no.
+
+D: OK. OK, so just to kind of summarize what we've talked about, over the last two weeks, you started having these 20 to 30 minute episodes of chest pain that's on the left side, it feels more sharp, is that correct? 
+
+P: Yeah.
+
+D: And it's kind of constant when it comes on, there's nothing really that makes it better or worse, it just kind of goes away on its own after half an hour or so, it has kind of stayed the same over over the last two weeks, hasn't really gotten worse or better, it hasn't gone away either? 
+
+P: Right, yeah exactly.
+
+D: You never had anything like that before and you have been, it sounds like experiencing some stress in your life, it definitely can play into that as well. OK, is there anything else that you wanted to to tell me about that I didn't ask you today?
+
+P: Uh, no, I think that's um, yeah, I think that's all that I wanted to talk about today.
+
+D: OK, so what I'm going to do is bring all this information to your family doctor and we can come back together and talk to you about the next steps.
+
+P: Awesome, thank you.
+
+D: Thanks for coming in.