jshargo/medical-interview-conversations huggingface dataset:
Patient: Um, I guess a little bit, yeah. Yeah, I guess a little bit and it's yellow. 

Doctor: It's yellow, OK, do you notice any kind of blood in your sputum? 

Patient: No, no blood. 

Doctor: OK, so just yellow sputum and how much would you say you're producing an average day?
Patient: Um, maybe like, 10 to 15 times in a day I produce enough to fill like the inside of my palm. 

Doctor: OK. And with the fever, did you get a chance to measure, take a temperature at all?
Patient: Umm, no, I haven't actually taken my temperature. 

Doctor: OK, but you've been having chills and are you having any other symptoms? 

Patient: Yeah, chills. I've been feeling kind of hot during the day. 

Doctor: Yeah, OK. And how about the shortness of breath, is that just during activity or you can have that when you're sleeping or resting as well?
Patient: The shortness of breath is more with like activity when I'm walking around. 

Doctor: OK. And have all these symptoms been getting worse at all? 

Patient: Yeah, I'd say they're getting worse now. It's like this everyday and it's definitely getting worse. 

Doctor: OK, do you feel dizzy or lightheaded at all?
Patient: Um, no. 

Doctor: Do you have any muscle aches? 

Patient: Um, a little bit. 

Doctor: OK, and where on your muscles would you say are aching?
Patient: I would say my lower limbs and just generally all over, but just yeah like the big muscles like my thighs, my shoulders. 

Doctor: OK. And have you been having any kind of swelling in your limbs at all? 

Patient: No, no swelling. 

Doctor: OK and any kind of swelling of your neck region or lymph nodes?
Patient: No, not that I noticed. 

Doctor: OK. And do you feel any kind of chest pain with shortness of breath?
Patient: Um, no nothing like that. 

Doctor: OK, and since you've been out of the hospital, have you been in contact with anyone who's sick? 

Patient: No, I went straight home. 

Doctor: And any recent travel?
Patient: No, no recent travel. 

Doctor: OK, any headaches? 

Patient: No headaches. 

Doctor: Any nausea or vomiting?
Patient: No. 

Doctor: Any kind of fatigue or increased tiredness? 

Patient: I feel fatigued, yes. 

Doctor: OK, and do you feel at all that your heart is racing?
Patient: No. 

Doctor: OK, and do you have any symptoms like a loss of taste, sense of taste or smell? 

Patient: No. 

Doctor: So, OK, any kind of bowel movement issues? Any constipation or diarrhea?
Patient: No. 

Doctor: And any urinary trouble?
Patient: Um, nothing like that. 

Doctor: OK, have you lost any weight recently? 

Patient: No. 

Doctor: Have you been able to sleep throughout the night or does the cough  wake you up or the chills wake you up?
Patient: Um, no,  they don't wake me up. I wouldn't say that. 

Doctor: OK. Are you having any other symptoms like a sore throat, runny nose, congestion, anything like that?
Patient: No. 

Doctor: OK, and anything in your house like dust or an old carpet or pets? Anything that triggers some of these symptoms? 

Patient: No. 

Doctor: OK. OK, and in terms of your past medical history, any conditions that you've been diagnosed with like asthma, COPD, anything like that?
Patient: Um, no, nothing like that. 

Doctor: OK, do you take any medications?
Patient: I do, I take some multivitamins particularly calcium and vitamin D, and I'm also on Synthroid. 

Doctor: OK, so do you have hyperthyroidism? 

Patient: Yeah, sorry I forgot to mention that. 

Doctor: No worries. Then when you went home and you were discharged, did they give you any antibiotics to finish at home?
Patient: Ah yes, they did. So I only had one days worth left. I was switched from IV antibiotic  to the oral kind and so I'd finish the remaining pills that day, then went home. 

Doctor: OK, so you finished the course, OK. Great and do you have any past history when you were admitted, any other hospitalizations or surgeries at all?
Patient: Um, no. 

Doctor: Do you have any family history of asthma, COPD or any lung conditions?
Patient: No. 

Doctor: Any other conditions that run in the family? 

Patient: No. 

Doctor: OK. And currently, where do you live?
Patient: I live in a house with my daughter and her husband. 

Doctor: OK, and any one of them have similar symptoms or have been sick recently?
Patient: No. 

Doctor: OK, and have you had a COVID test done at all?
Patient: Um, no, no COVID tests have been done. I had one in the hospital before I was admitted, but none today. 

Doctor: OK. And do you smoke at all? 

Patient: I used to smoke. I don't smoke anymore. 

Doctor: OK, and when did you quit?
Patient: About seven years ago. 

Doctor: OK congratulations.
Patient: Yeah. 

Doctor: And how much would you say you smoked before that, and for how many years? 

Patient: Before that, I would say it's like gosh, 20 years and then about a pack a day. 

Doctor: OK. Do you drink alcohol?
Patient: I drink like a glass of wine a week. 

Doctor: OK. Any other recreational drugs like marijuana?
Patient: No. 

Doctor: OK. Yeah, so is there anything else? Any other questions that you have for me today?
Patient: No, what do you think I have? 

Doctor: Yeah, so there's definitely multiple things that can be going on. Since you were just recently admitted, maybe you might have another bacterial r espiratory infection, like a pneumonia or it could be viral as well. So the first thing we want to do is for sure get COVID swab done and then we will also get, since you were admitted, as well recently, we want to get an X Ray on you just to see if there's any pneumonia. OK, and so we'll be keeping you here for a bit until everything comes back. We'll get some blood work done for you as well to see if there's any infection in your body. And then yeah, so just sit tight, we'll get all those things done. Is that OK with you? 

Patient: Yeah, that's great. Thank you. 

Doctor: You're welcome, yeah. So well will be updating you shortly.
Patient: Yeah, so like a couple months ago I was in the office and they told me that I have asthma like I had it when I was a little kid and I thought I grew out of it, but apparently not, or like it came back or something so. Yeah, so they just told me to come back today. I don't really have like any issues. 

Doctor: OK, So what what brought on the appointment in the summer time or a couple of months ago?
Patient: Uh. So like I have gym class at school and my teacher justalways thought that like should be able to run faster like I'm looking good athlete but I just couldn't go much faster and I was like saying I can't really breathe when I'm running that fast. And then you know my mom was like you should probably go. We should probably make an appointment. 

Doctor: OK, and uh, when you're exercising or in gym class, do you get short of breath or do you find that you have difficulty breathing?
Patient: Yeah, yeah, like I will if I if I try to run fast. Like I, kinda can't breathe anymore. So I kind of stop or go slower. 

Doctor: OK, and how long does it take for the breathing difficulty to go away?
Patient: If I stop doing like the thing I'm doing it, I I don't know not very long like couple of minutes. 

Doctor: OK, and uh, does this happen in any other settings? 

Patient: Oh, like sometimes when it's really cold outside, I'll go out and like it. My chest feels tight and just feel like I can't breathe and kind of sucks like my girlfriend wanted to build a snowman and do snow Angels and stuff and I couldn't do it. Oh, another time, like I went to my friends house and they had like a bunch of cats I I felt like I got wheezy sound and I felt like that time it took longer for for the breathing to get easier like I had to leave. 

Doctor: OK, so you've noticed changes to to your breathing sounds? Like you've had noisy breathing before?
Patient: Yeah, mostly just with the cat. 

Doctor: OK. 

Patient: We don't have a cat at my house, so I didn't really think anything of it. And then I went to my friends house who had a bunch of cats and. Then at that time, I could actually hear it. 

Doctor: OK, and have you had a cough?
Patient: Uh, no, I don't think so. 

Doctor: OK, And. Were there anything, was there anything that you tried besides the rest to make those symptoms go away?
Patient: Like I have the, uh um inhaler that the DOCTOR: gave me last time. So yeah, like I've been using it in gym class now. 

Doctor: OK, how many days per week are you using that?
Patient: Well, I'm a little confused now because. I the 1 supposed to use, like every day a couple times, and then there was a different one that I thought it was only supposed to be used if the other one didn't work. But now the nurse just told me that I'm supposed to use them both, so I only got the one at the pharmacy so I don't really I don't really know. I feel like a bit confused now, but I always use the 1 supposed to be like 2 times a day, the one that starts with an "s", um but sometimes I just do it once a day if I forget the second one. 

Doctor: OK, well um we can definitely clarify the confusion about the medications today. Sometimes, for steroid medications, those ones are required to be used daily in order to get the maximal benefit, and so will take a look at your medications and see if one of those has a steroid component in it and say and how often you're needing it. Have you been having any episodes of shortness of breath at night time? 

Patient: Oh no. No, mostly like gym class like I said. 

Doctor: OK. And have you had any other associated symptoms?
Patient: Uh. I don't think so. Like what do you mean? 

Doctor: Um, so anything like like allergies like runny nose or really itchy eyes with maybe some like um tearing?
Patient: When I was around the cats, yeah. But not the other times. 

Doctor: OK. And do you ever have any rashes on your skin or or really itchy skin?
Patient: When I was a kid but not really now. 

Doctor: OK, and how about any nausea or vomiting? 

Patient: No. 

Doctor: OK. Any infectious symptoms overall?
Patient: Ahh, I don't I don't think so. 

Doctor: OK, any urinary problems? 

Patient: Uh, like. No, no. 

Doctor: OK. Bowel problems?
Patient: uh no, no. No, that's all good. 

Doctor: OK um. And, uh, any fevers or chills? 

Patient: No. 

Doctor: OK, and then how about, uh, have you been having any night sweats?
Patient: What's that? 

Doctor: So, uh, overnight when you're sleeping you wake up with either your like pajamas drenched, or your your sheets drenched drenched from sweating. 

Patient: Oh no. 

Doctor: OK.
Patient: Um not that. 

Doctor: OK. So I just wanted to ask a few questions about your past health. Have you been, so you mentioned asthma. Have you been diagnosed with any other medical conditions?
Patient: No, no that's it. 

Doctor: OK, um, and any recent hospitalizations? 

Patient: Like I broke my leg years ago but like that was just like really fast. 

Doctor: OK, and any surgeries?
Patient: Uh. Just like my wisdom teeth. 

Doctor: OK, and any medications besides it like that, including the inhalers? 

Patient: Nothing else, just. Just those things and my mom makes me take a vitamin. 

Doctor: OK, and any allergies?
Patient: What I don't know like not that I thought, but maybe like cats. 

Doctor: OK, and do you have any like seasonal allergies? Do you find like in the spring or fall time or even summer that you get um like dry eyes or really itchy eyes or runny nose? 

Patient: Yeah, I just thought like I had a cold, but I guess like I usually feel like that in the springtime. 

Doctor: OK. And, uh, are immunizations up to date?
Patient: I think so, like I've had all the stuff that I'm supposed to. I think I don't know the names of everything. 

Doctor: OK, and so I actually wanted to ask a few questions about personal and kind of lifestyle habits. But first I was wondering if you could tell me a little bit about your living situation? 

Patient: You know, like I live with my mom and Dad and I like my little brother. 

Doctor: OK.
Patient: Yeah. 

Doctor: OK, and um, where do you go to school? 

Patient: Um to to the. The school, um like high school down the road. 

Doctor: OK and in what grade now?
Patient: And, I'm in Grade 11. 

Doctor: OK, and what types of like hobbies or kind of activities are you interested in?
Patient: I like I like playing video games, I was really wanting to join the Marines and I was really trying to get into that stuff, but then I heard like you can't when you have asthma. Oh so I I kinda wanna know bout that like is that gonna stop me from doing that? 

Doctor: Yeah, so it's something that we will look into today. I'm. I'm not too sure what the details are regarding that information, but thank you for bringing that up and we'll be for sure to look into that together. And that reminded me of a question I wanted to ask earlier and so have you had pulmonary function tests done before? 

Patient: Uh, what is that? 

Doctor: So essentially they'll have you kind of breathing into a tube where you'll have periods where you'll maximally inhale and then maximally exhale as quickly as you can, and you'll do different types of breathing movements so that it gets measured on a on a device.
Patient: Is that like when you breathe in that the tube? 

Doctor: Yeah, exactly.
Patient: Yeah, like the last time I was here like couple months ago I did that and it said that, she said that my asthma was back. 

Doctor: OK. Right, thank you for clarifying. And so, so for the last few questions about. And your personal habits. I was wondering. I understand that people in your age group might experience with smoking or or alcohol. Do any of your friends do that?
Patient: I mean, sometimes we'll drink beer like at parties on the weekend. I don't, I don't drink a lot. 

Doctor: OK, and can you tell me a little bit about your diet?
Patient: Sorry I missed that. 

Doctor: Just wondering if you could tell me a little bit about your diet?
Patient: Oh, well my mom always like makes me a lunch like I'll have like a sandwich for lunch with like you know ham and cheese or something. I'll usually have like cereal for breakfast and my mom makes dinner. It's usually like meat like potatoes and vegetables or something. I think it's like pretty normal. 

Doctor: OK, and are you currently sexually active?
Patient: Uh. Like I have a girlfriend. Just with her. Uh, like just recently. Yeah we started. 

Doctor: OK, and do you use a condom? 

Patient: Yeah, yeah. 

Doctor: Every time or sometimes?
Patient: Oh yeah, every time. It's not doing that many times, but yeah. 

Doctor: OK, great and um have you had any other partners?
Patient: No, no like I had made out with other people before, but this is like the first one. 

Doctor: OK, but have you had a sexually transmitted infection before? 

Patient: Uh no. 

Doctor: OK, and I know this question might seem a little bit invasive, but it's important to ask everybody. Have you had any thoughts of hurting or harming yourself?
Patient: No. 

Doctor: OK. 

Patient: No I haven't. 

Doctor: OK, great um. And in your family, has anybody ever had any of these similar symptoms before?
Patient: Like may my dad, I think he maybe had asthma when he was younger, but like he doesn't really have it now. 

Doctor: OK, and any allergies that run in the family?
Patient: Mmmm, like my dad also really. Dad gets like a runny nose in the spring. So yeah, I think that's allergies. 

Doctor: OK. um. So overall, it's it's sounding like you been having this shortness of breath or difficulty breathing episodes that you're saying that it's made worse when you're exercising, out in the cold, and then around pets. And sometimes when the season changes as well and in the spring and so and then the recent diagnosis on pulmonary function tests a few months ago. So I think it would be important to clear up the medications today and try to get that better organized moving forward because it sounds like you're still pretty symptomatic with needing to use them daily currently. And so will look into that and then also the question about the Marines. Uh, interest with asthma.
Patient: So, just for the past, like 3 days I've been coughing. It's I I don't feel particularly sick. I'm just kind of dry like annoying call that won't go away and then today I took my temp in it It's pretty high. It was like 99 point like 9. I didn't really take it the other days, so I guess so I just thought I'd better come get it checked out because I, I am on like a biologic medication, so, for my Crohn's disease. 

Doctor: OK, yeah. Yeah, thank you for coming in. I think it's good that you are getting this checked out as early as possible. So just to rewind a little bit. When did your dry cough start? 

Patient: Uh, like 3 days ago three days ago. 

Doctor: 3 days ago, OK. And when did your fever start?
Patient: So I didn't take my temp, but like the other days, but like for sure this morning. 

Doctor: OK um, OK, so the cough is it always a dry cough or do you sometimes bring up sputum or blood? 

Patient: Yeah, it's always a dry cough. It's really just annoying. 

Doctor: Yeah, yeah. Do you feel wheezy at all?
Patient: Uh, no. 

Doctor: No wheeziness, OK. How about short of breath?
Patient: Hi, I am just coming in because for the last couple of months but I've been having this, these coughing fits. Are there like when I'm going to the gym or even at home, like during the weekends when we're vacuuming and cleaning the house. 

Doctor: When did this start? 

Patient: Um, I would say started, uh probably 3 months back, but it's gotten worse, so like before I used to like just have some irritation in my throat and cough a little, but now, I would say probably every other day I'm having these episodes where I can't stop coughing when I'm exercising. 

Doctor: Hmm, um and is this cough a dry cough, or do you bring up some mucus?
Patient: It's usually, it's usually a dry cough and sometimes I do bring up like this light material, but usually it's mostly a dry cough. 

Doctor: You never notice any blood, right?
Patient: No, no blood. 

Doctor: OK and uhm, it started about three months ago, I guess before that did you ever have a problem when you would exercise or when you were vacuuming or cleaning, has this been a problem that has occurred for years and that's just something that you that got worse and now it's come to your attention? Or was it just very new and sudden, three months ago?
Patient: Um, it's fairly new. I've never really had this issue before although I have been like so like after the new year in the winter I, I, I wasn't much of the person who ran or exercised a lot. But I, I kind of needed a new goal to become more fit and active. So I notice that, I don't know, maybe that's why like, it is something new that I've been trying, but yeah, it's not been an issue before. 

Doctor: OK, and other than the the cough, have you noticed any other symptoms like a sore throat or itchy eyes? Itchy nose? Stuffy nose or runny nose? Anything like that?
Patient: No, none of those, but I did it, initially I used to get just an irritation in my throat. But now it's just more of a cough. 

Doctor: OK. Do you have, do you get any pain in your chest at all? 

Patient: Uh, when I'm usually it goes away in 10-15 minutes but when I'm coughing a lot I do get some tightness. 

Doctor: OK. Do you ever feel like you're short of breath when you're coughing or otherwise?
Patient: I do find that it's harder to take a breath at those times. 

Doctor: Ok. Uhm and how long do these last for? Episodes last for?
Patient: Probably, uh 15 to 20 minutes and yeah, it's it's mainly just after I like often times over the last few weeks I've had to just stop doing what I'm doing, like exercising and just come home and rest. 

Doctor: Do you feel like your hearts beating really fast when that happens or you're sweating? 

Patient: Yeah, yeah, I I feel like it's usually, I don't know if it's because of the exercise, but I have like a Fitbit and it's my my heart rate is much faster. 

Doctor: Uhm, OK. Alright. Have you had any other symptoms so anything, any pain in your belly or any nausea or vomiting?
Patient: No, nothing like that. 

Doctor: Any changes in your bowel movements or any urinary symptoms?
Patient: Nope. 

Doctor: Any headaches or fevers or chills? 

Patient: No, nothing like that. 

Doctor: Unintentional weight loss?
Patient: No. 

Doctor: Muscle aches, joint pain? 

Patient: No. 

Doctor: Have you been diagnosed with any medical conditions?
Patient: No, I've I've been very healthy. 

Doctor: Uhm, you mentioned that you started going to the gym more often earlier this year, and that is when you sort of notice some of these symptoms? Is there anything else that changed in your life? Any big changes that you think could be related to this?
Patient: Um no, not really, I've I've been really, umm, I moved back to my parents' home just for a bit right now. 

Doctor: Ok.
Patient: Now, while the University has closed down, and by that I've lived there all my life before, so I don't know if that had anything to do with it. 

Doctor: Do you feel like they may have put new curtains or or like there's old carpets or new a new pet, or something that could have caused some irritation for you? 

Patient: No, but I have noticed that when I when we vacuum. I, I do get some of those symptoms as well. Just more of an irritation mores than the cough. 

Doctor: OK. OK, and do you feel that you're particularly anxious when these episodes are occurring? Do you have any new stressors in life?
Patient: Uh, no, not really. 

Doctor: Any medical conditions that run in the family?
Patient: Uhm, I don't think so. Not that I know of. 

Doctor: OK, and I guess a little bit more about you. So have you had in the past when you were younger, did you have a rash like eczema or did you have allergic rhinitis where you would sneeze and, to feel ill when you were outside or at certain times of the year? Anything like that? 

Patient: I didn't have a, I didn't have any like exam or rashes, but I do generally have umm, get allergies during the spring time when I go outside. 

Doctor: Do you take any medications for that?
Patient: I just take Reactine usually during the spring. 

Doctor: Do you have any other allergies? To food or medications? 

Patient: No, not that I know. 

Doctor: And other than Reactine, do you take any medications, including over the counter meds?
Patient: No. 

Doctor: Nothing else? OK. And. In your family, you said no one has asthma or allergic rhinitis or eczema or anything like that, right?
Patient: Not asthma, my dad also gets those allergies and irritations just like me. 

Doctor: Uhm, OK. And you mentioned that you're staying with your at your parents place. Are you uh, are you doing things from home? Are you like doing school from home or working from home? 

Patient: Yeah, I'm not currently working, just studying from home. 

Doctor: OK, and have you had contact with anyone who might have been sick?
Patient: No. 

Doctor: Traveled anywhere outside the province, recently?
Patient: No. 

Doctor: OK, and do you smoke or have you ever smoked?
Patient: No, never smoked. 

Doctor: Marijuana? 

Patient: No. 

Doctor: Any recreational drugs?
Patient: Nope. 

Doctor: Uh, do you drink alcohol or have you ever had alcohol in the past?
Patient: Yeah, alcohol I've had like at University, but generally, maybe just on the weekends. Not anything regular. 

Doctor: Alright. OK, well, uh, those are all the questions I had for you. We will do a physical exam now and I'll go talk to my attending and we'll uh come talk to you right after. I guess before before I do So what exactly are you hoping to get out of today's visit?
Patient: I just wanted to like I really do you want to become fit and it's just these symptoms are stopping me and kind of affecting my daily routine, so I just wanted to know what I can do to stop like having these symptoms. 

Doctor: Have you ever tried any puffers?
Patient: No, I haven't. 

Doctor: No, ok. Right, yeah, let's talk a little bit.
Patient: Hi, I've I've just been. I've been sneezing a lot and I have this runny nose. It's just been very irritating. I kind of want to do something about it. I've had it for awhile, but it's just. You know, I decided to like, come in to find out what's. What's wrong with me? Why do I like? Why does this happen to me? All my friends are OK. 

Doctor: Oh yeah, I know it must be very, very irritating. How long has it been going on for?
Patient: It's been years, I don't even remember. 

Doctor: Oh years, OK and years like just sneezing and the runny nose has been going on for the last few years.
Patient: Yeah, it kind of kind of comes on like around the spring time. It just gets really bad at that time. 

Doctor: yeah? OK, and are there any besides during the spring time, any kind of allergens or any anything in the house or around you that triggers it, like dust or anything like that?
Patient: Yeah, dust makes it a lot worse. Like when I have to vacuum the house, I just feel awful for the next two days. 

Doctor: I see, do you get any other symptoms besides the, uh, sneezing and runny nose? 

Patient: Yeah, let my nose so stuffy and sometimes it's just like my eyes and my nose are just itchy and my eyes get like red and teary sometimes. It's so embarrassing when I'm going to school. I also wake up in the morning with this like sore throat and have just cough and clear out my, you know clear my throat. 

Doctor: OK, and does that happen like every morning?
Patient: It's usually worse around springtime. 

Doctor: OK. and are you coughing at all?
Patient: Well, I have to like cough to clear my throat but then not otherwise. 

Doctor: OK, and are you bringing up any sputum? 

Patient: Yeah, that yeah I do. 

Doctor: Like, uh, how much would you say? Do you just bring it up in the morning, or like throughout the day,
Patient: just in the morning, 

Doctor: just in the morning? 

Patient: Yeah 

Doctor: Do you have a sensation of like anything kind of dripping down your throat like after you wake up like just a build up?
Patient: Yeah yeah I do. 

Doctor: Ok. And besides that, have you been having any symptoms of fevers, chills, sore throat?
Patient: I get a bit of a sore throat, I guess in the morning, but it just goes away after. 

Doctor: OK, 

Patient: But no fevers. 

Doctor: OK, and is there anything that you've tried at all, like medications or anything that has helped you with these symptoms?
Patient: Uhm yeah, I tried like umm Reactin and that really helped. 

Doctor: That helped OK that's good and are you taking Reactin right now?
Patient: I didn't take it today. I tried it a couple days ago. 

Doctor: OK. And have you traveled at all recently?
Patient: No. 

Doctor: No, OK, and any sick contacts, anyone around you that has been sick? 

Patient: I don't think so. 

Doctor: OK, any headaches?
Patient: No. 

Doctor: Any nausea or vomiting? 

Patient: no. 

Doctor: Any fevers or chills?
Patient: no. 

Doctor: Any kind of fatigue or tiredness throughout the day?
Patient: I do feel more fatigued when I have these symptoms. 

Doctor: OK, any night sweats, fevers, or chills? 

Patient: no. 

Doctor: Any changes in your bowel movements at all?
Patient: No. 

Doctor: Any trouble urinating? 

Patient: no. 

Doctor: Any changes to your appetite or weight?
Patient: I've been losing weight, but I've been dieting and working out more. 

Doctor: OK, and how much weight would you say you've lost over the last few months? 

Patient: I've lost about four pounds in the past four, five months. It's been hard to lose weight. 

Doctor: And so no, no sudden like loss of weight or anything like that right now?
Patient: No, no, no 

Doctor: Well, it's really great that you're, you know, trying to lose weight and dieting and and having like a healthier lifestyle. It is definitely harder with the pandemic going on right now to to get in the activities. And it's hard like being at home, and sometimes it's really difficult to like not eat right
Patient: Yeah yeah true. 

Doctor: So besides besides that any kind of recent exposures to any fumes, dust, animals, pets like anything like that? 

Patient: Yeah, it was kind of like vacuuming a couple of days ago when it got really bad, but nothing. Not not. I don't think there's not been any other exposures. 

Doctor: OK. And do you have any past medical conditions that you have been diagnosed with like asthma, eczema, anything like that?
Patient: I haven't been diagnosed with anything. No. I did have like I know that I would sometimes get kind of short of breath as a child. But my mom doesn't really trust doctors, so she wouldn't take me to one. 

Doctor: OK, have you had shortness of breath after that, like when like as a child, how old were you? 

Patient: I must have been like 8 years old or 9 years old that I remember, but I think I've had it before that as well as my mom tells me. 

Doctor: Oh OK, do you have that at all now?
Patient: No, no, I don't. 

Doctor: OK, OK Have you ever seen an allergist before? 

Patient: No, no. 

Doctor: No OK. Do you have any known allergies to any medications? Yeah any medication?
Patient: no 

Doctor: no. Do you take any medications at all on a regular basis?
Patient: No. 

Doctor: No, OK. Have you been hospitalized or had any surgeries in the past? 

Patient: No. 

Doctor: Any family history of any asthma, eczema, allergic rhinitis. Anything like that?
Patient: Yeah, I think it kind of runs in my family like everyone in my family is just kind of always having this runny nose and sneezing. My mom has it. My younger brother has it. But like we haven't really been diagnosed with anything like we, we rarely go to the doctor. 

Doctor: OK, OK, and currently right now, do you work at all? Or sorry, do you go to school?
Patient: I do I do. I've been doing it virtually. 

Doctor: Virtually OK, so have you noticed anyone sick around you? 

Patient: No. 

Doctor: No OK. And what at home? What's your living situation like? Who do you live with?
Patient: I live with my mom, dad and my younger brother. 

Doctor: And, yeah, I just want to let you know that any questions I ask you today and anything we talked about it's completely confidential and unless like there is any potential harm to yourself or anyone anyone else. So yeah, I'm just gonna ask you a few questions. Do you feel safe at home? 

Patient: Oh yeah. 

Doctor: OK, and do you drink alcohol at all? Or have you tried alcohol?
Patient: No, not at all. 

Doctor: Have you tried any recreational drugs like marijuana? 

Patient: No. No. 

Doctor: How about smoking?
Patient: Umm no 

Doctor: no OK, and are you sexually active? 

Patient: No. 

Doctor: No OK. And so overall, do you feel safe in your home and as well as outside of your home environment? Any kind of bullying or anything like that going on?
Patient: No, not at all. 

Doctor: OK, alright. Yeah, so those are kind of all the questions that I had for you. Sorry just one more question, any loss of sense of taste or smell?
Patient: Yeah, it's hard to smell and my nose is stuffy, but no loss of taste. 

Doctor: Yeah, OK. OK, so do you have any questions at all for me?
Patient: No, I just I I just wanna get some medications to help with this. I'm just sick and tired of my runny nose. 

Doctor: Yeah, it must be very frustrating. So you've tried Reactin before, right?
Patient: yeah 

Doctor: Yeah, so one method is to definitely like stay away from some of those allergens that are potentially causing your symptoms. But I I do really think so you might have something called like allergic rhinitis. And I think it might be beneficial to for you to see like an allergist
Patient: sure. 

Doctor: And so I can refer you to someone as well. Just have a sense of what kind of things allergic to you and like what medications you would require. In the meantime, definitely like any antihistamine medications would help with your symptoms. But since you're also having congestion and sneezing, just just in case, we will just do a COVID swab test for you today. And it takes around 24 to 48 hours to come back. And in the meantime, you should just isolate as much as you can in your own home. And then based on the result they would give you more instruction. 

Patient: Sure 

Doctor: Alright. Thank you, take care.
Patient: Yeah, I've just been feeling breathless and it's getting worse. So I wanted to check it out. 

Doctor: OK, and when did you first start feeling breathless? 

Patient: About two months ago. 

Doctor: OK, and did it come on about like gradually through time or suddenly just happened?
Patient: I guess gradually, yeah. 

Doctor: OK. And, do you feel, uh, how often do you feel breathless?
Patient: 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. 

Doctor: OK, and were you able to walk normally more than 50 meters before two months?
Patient: Yeah, three months ago I was fine. 

Doctor: OK. And do you have any other symptoms like cough or chest pain? 

Patient: I have a cough sometimes, yeah. 

Doctor: OK, but nothing like constant?
Patient: No. 

Doctor: OK, and do you have any wet cough or any productive cough or are you producing like sputum or phlegm? 

Patient: Yeah, I guess I'd say I have this frothy sputum. 

Doctor: OK, and has your breathlessness been getting any worse at all over the last two months?
Patient: I would say so, yes. 

Doctor: OK, and you mentioned like exertion makes it worse, but anything else like going outside or exposure to any chemicals that makes it worse?
Patient: Uh, I don't think so. 

Doctor: OK, and how about a positional changes? Does lying flat at all make it worse?
Patient: I would say so, yes. Yeah, I'm basically gasping for air when I lay down. 

Doctor: OK, and do you ever find yourself waking up at night in the middle of the night to catch your breath? 

Patient: No. 

Doctor: No, OK. And when do you feel the breathlessness the most? Is it more so during the day or at night?
Patient: I guess it's worse at night because I'm laying down. 

Doctor: OK. Great and, in terms of how many flights of stairs you can climb before you start feeling breathless, do you have a number? 

Patient: I would say like 3/4. 

Doctor: 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?
Patient: No, nothing like that. 

Doctor: OK, and prior to two months, have you ever had any similar experiences? 

Patient: Prior to 2 months? No. 

Doctor: OK. And, does anything make it better? Like any positional changes makes the breathlessness go away?
Patient: 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. 

Doctor: OK, and are you having any other symptoms like sore throat, runny nose, chest pain, dizziness, anything like that?
Patient: No. 

Doctor: OK. Have you recently traveled outside of the country?
Patient: No. 

Doctor: Have you recently had any surgeries?
Patient: No recent surgeries, no. 

Doctor: OK, any headache nausea or vomiting? 

Patient: Um, no. 

Doctor: OK, any fevers or chills or night sweats.
Patient: No. 

Doctor: OK. Do you feel increasingly fatigued throughout the day? 

Patient: Uh, I would say so, yeah. 

Doctor: OK. And any changes in your bowel movements at all?
Patient: No. 

Doctor: OK, and any chest pain at all within the last two months?
Patient: No, no chest pain. 

Doctor: OK. Any swelling in your in your legs, ankles, or in your hands and arms? 

Patient: There is some swelling. 

Doctor: OK, and uh, where do you, where are you getting this swelling?
Patient: Around my legs. 

Doctor: OK, and how when did you first notice this?
Patient: Around the same time actually two months ago. 

Doctor: OK. Have you noticed any kind of fevers at all?
Patient: No. 

Doctor: OK. Have you been in contact with anyone that has been ill recently?
Patient: No no. 

Doctor: OK, and have you been coughing up any blood at all? 

Patient: No. 

Doctor: OK, any weight loss?
Patient: No. 

Doctor: Any night sweats or chills?
Patient: No. 

Doctor: OK, apart from the breathlessness when laying down, any other issues with your sleep?
Patient: No. 

Doctor: Any changes in your appetite?
Patient: Nope. 

Doctor: OK, have you had any recent infections like a cold at all? 

Patient: No. 

Doctor: OK, any exposure to tuberculosis in the past?
Patient: Not that I know of. 

Doctor: OK, any exposure to fumes or dust within your home or work environment? 

Patient: No. 

Doctor: OK, any animals or pets in the house?
Patient: No, no. 

Doctor: 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?
Patient: Um so, yeah, so I have high blood pressure, diabetes and high cholesterol. 

Doctor: OK, and do you take any medications for this?
Patient: Yep, so I take aspirin, ramipril and simvastatin. 

Doctor: OK, and have you ever had any chest pain or heart attack in the past?
Patient: Yeah, actually I had a heart attack four years ago. 

Doctor: OK, and do you remember what they did for your heart attack? 

Patient: Something like a stent or something. 

Doctor: OK, and since then you've been on these medications?
Patient: Yes. 

Doctor: OK, and after they managed your heart attack, have you ever had similar symptoms to when you had your heart attack? 

Patient: No, no. 

Doctor: nothing like that? OK. Do you have any allergies to any medications?
Patient: No. 

Doctor: Any environmental allergies?
Patient: No. 

Doctor: OK, and have you previously had any surgeries in the past? 

Patient: Um, I guess the stenting. 

Doctor: Just the stenting? And apart from that, have you had any other previous hospitalizations?
Patient: No. 

Doctor: OK, and any family history of any cancers or heart attacks?
Patient: Um, my father died of a heart attack when he was 60. 

Doctor: OK. And currently do you work at all? 

Patient: I do, um, I work as a cashier. 

Doctor: OK. And has the shortness of breath been affecting your daily routine at home or at work at all?
Patient: 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. 

Doctor: OK. And at home, do you currently live with anyone or do you live by yourself? 

Patient: I live by myself. 

Doctor: OK, and do you live in an apartment or house?
Patient: I live in an apartment. 

Doctor: OK, and are there any exposures like dust or mold or asbestos in your home environment?
Patient: No. 

Doctor: OK. And currently do you smoke? 

Patient: Not right now. I used to smoke. I used to smoke 10 a day for like 40 years. 

Doctor: OK, and do you use any recreational drugs like marijuana?
Patient: No. 

Doctor: OK. Any alcohol?
Patient: No. 

Doctor: OK. And in terms of your daily routine, do you feel that you get 3 meals a day, a well balanced diet? 

Patient: I wouldn't say well balanced. I'm trying to eat healthier but doesn't always happen. 

Doctor: OK, and how about exercise? Do you find that your exercise levels or activity levels have gone down in the last two months?
Patient: Um I'm here because my left hand, kind of just like at the base of my thumb, has been hurting for the past two days and it seems to be getting worse, um and I'm left handed so it's really hard for me to write or do anything um where I have to like, clench or grip things. 

Doctor: OK, and how long has this been going on for? 

Patient: Uhm, so for the past two days, but it's got, it got bad yesterday. 

Doctor: OK, and have you had any, uh if you were to describe the pain, where is it located exactly?
Patient: It's just at the base of my thumb. Uh you know where the fleshy part of your hand is? 

Doctor: OK yeah yeah. 

Patient: Yeah, so just just over there. 

Doctor: OK, and what kind of pain is it? Is it sharp or is it aching?
Patient: Uhm, it's it's like a um, at baseline it's an achy pain, but if I try to move it or um try to write or you know, use a computer or anything like that, it becomes sharp. 

Doctor: OK, Um and on a scale of uh zero to 10, 10 being the worst pain you've felt in your life, how much would you rate it? 

Patient: I'd say like a 6. 

Doctor: OK, and does this pain move anywhere else in your hand, or does it just stay where you described?
Patient: Um it just stays there. 

Doctor: OK, and what kind of motions uh cause the most pain?
Patient: I'd say like um you know, trying to touch my pinky with my thumb, that that hurts. Um just like trying to rotate it hurts. 

Doctor: OK, um have you tried anything for the pain that has helped?
Patient: Uhm, no, I haven't really tried too much. I've just I just tried not to use it as much. 

Doctor: I see. OK. And um, has this ever like, have you ever had any injuries to this hand? Any trauma either recently or in the past? 

Patient: No, no, nothing like that. 

Doctor: OK. Alright, and is there any, do you do any kind of repetitive work that requires gripping or lifting um with that hand, anything repetitive?
Patient: So I do a lot of work at the computer. And um I guess I tend to type a lot with my left hand, so maybe that. 

Doctor: OK.
Patient: And sorry I also take lots of notes, like handwritten notes with my left hand. 

Doctor: OK, so are you left handed?
Patient: Yes. 

Doctor: OK. Alright. Have you been diagnosed with any medical conditions in the past?
Patient: No. 

Doctor: No, so you're healthy? 

Patient: Yes. 

Doctor: Um do you take any medications on a regular basis?
Patient: Uh no, no. 

Doctor: No, OK. Any allergies to any medications? 

Patient: Um no allergies. 

Doctor: OK, um any previous surgeries or hospitalizations?
Patient: No. 

Doctor: No, any family history of any medical conditions, whether it's musculoskeletal, rheumatological, any conditions?
Patient: Uh no, nothing like that. 

Doctor: OK, um any cancers in the family?
Patient: Um I know there's, yeah there's a lot of cancer in the family. There's colon cancer, breast cancer, ovarian cancer. 

Doctor: OK. And are they first degree relatives who had those cancers?
Patient: Uh no first degree relatives, just like aunts and uncles. 

Doctor: OK. Uh alright, and currently are you working right now or have you had any time off work or any modified duties? 

Patient: Um so I'm still working online, I've just um haven't been taking notes by hand anymore. 

Doctor: I see, and does that help though?
Patient: Uh yeah it it has helped a little bit because I'm not moving my hand as much so it helps with the pain. 

Doctor: OK. Have you taken any uh Tylenol, Advil, anything for the pain?
Patient: No, I haven't. 

Doctor: OK. Alright. And currently right now, what is your living situation like? 

Patient: Uh I live in an apartment by myself. 

Doctor: OK, and um, do you currently uh smoke cigarettes?
Patient: Um I smoke, I used to smoke like five years ago, and I only did that for like a year or two, um and it wasn't very much. But I don't smoke anymore. 

Doctor: OK, that's good. Um any alcohol? 

Patient: Um I'll have like a beer on the weekend. 

Doctor: OK. Any recreational drugs like marijuana?
Patient: Um I will take an edible like once a month. 

Doctor: OK. Um and yeah, those were just some of the questions I had um and we're just going to do a few things for examining, examining uh that area. So are you able to make a fist? 

Patient: Um I can, but it hurts. 

Doctor: OK, it hurts in that location that you mentioned?
Patient: Yes. 

Doctor: How about um if you make a fist without your thumb, does it still hurt or is it just when you are moving the thumb?
Patient: It's just when I'm moving the thumb. 

Doctor: OK. And if you were able to, are you able to uh rotate your wrist?
Patient: Uh yes, I can rotate my wrist. 

Doctor: Does that hurt at all?
Patient: No. 

Doctor: OK, um now I just want you to do this one test. It's called a Finkelstein test. OK so I want you to flex your thumb, press it up down against your palm. 

Patient: OK. 

Doctor: And then hold your hand, sorry.
Patient: No, go ahead. 

Doctor: Yeah, and then after you do that, um, bring your fingers above your thumb, so just cover your thumb.
Patient: OK. 

Doctor: Kind of like a fist, but your thumb is on the inside of your fingers. 

Patient: OK. 

Doctor: And then bring your uh arm out.
Patient: OK. 

Doctor: And with your other hand, can you, from above push your wrist downwards? So your uh pinky finger is uh pointing to the pointing to the ground.
Patient: OK, yep. 

Doctor: Yeah, and did that hurt at all? Like when you, so this is just called ulnar deviation or your um of your wrist. Does that hurt at all?
Patient: Yes, that is very painful. 

Doctor: That's very painful, OK. Alright, um and then you're also having pain with gripping and, OK, so those are kind of all the things I wanted to ask. Uh it seems that you may be having something called De Quervain's tenosynovitis. Um it's caused by some repetitive motions, uh it can be due to gripping. Sometimes it happens to new mothers who are lifting their children as well as daycare workers. It can also happen in other work environments, and so what we will first just need to do um is mainly to rule out something like osteoarthritis. You are fairly young um but if there was ever an injury in the past, it you can have early osteoarthritis in the area. So we just want to get an X-Ray. And other than that, the way we kind of deal with this issue is usually conservatively and with a splint.
Patient: OK. 

Doctor: And a sling for your thumb that uh helps relieve some of these symptoms, uh restricts some of your movements, reduces some of the swelling, and if it does get really bad and it's affecting your work and conservative management with pain and the splint don't work, and with physiotherapy, we do uh offer injecting corticosteroids into just right like in the area that you mentioned, right below the thumb. 

Patient: OK. 

Doctor: Um and that often has some effect as well. Um but at first, yeah, let's just do some conservative management and see if that helps. It's only been a few days, so hopefully um what we try first helps. And then we can go on from there.
Patient: OK yeah, that sounds great. Thank you. 

Doctor: Welcome, take care.
Patient: My back, it just really hurts. I feel really stiff in the morning and um yeah, it's just been going on for a few months now. 

Doctor: Ok, so for a few months, stiffness in the morning. So your back hurts, where exactly would you say it hurts?
Patient: It kinda hurts all over. I can't really pinpoint any specific locations that hurts most, kind of hurts like all down my my back. 

Doctor: OK, all the way up to I guess your neck and all the way down to your lower back?
Patient: So I wouldn't really say the neck, and I guess more of the the lower parts. Maybe like the middle of my back and... 

Doctor: I see.
Patient: And down. 

Doctor: Ok and what kind of pain would you say it is, is it like a dull aching pain? Is it a sharp stabbing pain? How would you describe it?
Patient: It's a dull pain. 

Doctor: Dull pain, ok. Ok, and on a scale of 0 to 10 with 0 being the least amount of pain you felt in your life and 10 being the worst, how much would you rate it?
Patient: It's about a four or five. I mean some days it can be better, but yeah, some days it can be worse. 

Doctor: OK and when did this start? 

Patient: I think this started about like four or five months ago. It's been going on, yeah, for probably about half a year now. 

Doctor: OK, and when it first started up, was there anything that caused the back pain? Like any kind of trauma or injury, anything that you can think of that might have led to this?
Patient: No, nothing that it's I I can think of. It's sort of it's come on so slowly like when I first started noticing the back pain it it was maybe like a 0 to a one. I didn't really notice it too much, but over these last 5, 6 months it has gotten has gotten a bit worse. 

Doctor: Ok, so it kind of came on progressively. Didn't just come on suddenly at some point? 

Patient: Right, yeah, it's been getting worse. 

Doctor: Ok, and have you ever had any previous episodes that are similar to this?
Patient: Uh, not not in my back pain. I do get pain in my right knee and in my hands sometimes. But those pains just kind of come and go. 

Doctor: Ok, and when did those pains start? 

Patient: Uhm, those ones started, probably similar timeline around six months ago. 

Doctor: Ok, ok. And in the back pain that you're having, does it radiate or move to any other part of your body?