Transcript

Doctor: Hi, um, are you bill snook? Patient: Hey doc. Yeah, and this is my wife Sarah. Family Member: Hi. Doctor: Hello. I'm dr. Keith Thompson. Nice to meet you both. What brings you here today? Patient: I I've been having some pain in my chest Doctor: Okay, when did that start? Patient: I Guess I first noticed it about a year ago Family Member: That long I thought it was just a few months ago Patient: No, it has been longer I didn't want to worry you Doctor: Okay. So why don't you tell me a little bit more about the pain? Patient: It's uh, it just keeps coming back and I'm kind of worried about it. Doctor: Yeah, okay Where is it in your chest exactly? Patient: It's right in behind here Doctor: Okay, so that looks like you're pointing to your chest and the epigastric area. Family Member: Oh That could be a heart Could it be it's a heart doctor Doctor: Yeah, let's get a more of a history and then we can figure out what this is What does the pain feel like is it sharp like a knife or dull or burning? Patient: It's um, it's kind of like it's burning feeling Doctor: Okay, is it there all the time or does it come and go? Patient: No, it's come and go comes and goes and sometimes I think it's gone for good But then like a day later It's back again Doctor: Okay. So when it comes how long does it last for is it like a few seconds and it's fleeting or is a few Hours, or is it all day? Patient: Sometimes it can go on for a few hours, you know, I guess it depends Doctor: What are you usually doing when it comes on like is this related to activity? Does it come on when you're running or anxious or is it just sporadic Patient: Sometimes it comes on after I have eaten or had a cup of coffee Sometimes it just comes on which seems Family Member: So it doesn't happen after you your jogs in the morning I know you know that I don't like it when you go early in the morning on your own Patient: No, honey, I will tell you Doctor: Okay, is there anything that makes it better Patient: Yeah, Tom's helps a bit and a glass of milk quiets it down for a little while Doctor: Yeah, okay. Have you ever had anything like this happen before? Before a year ago Patient: Yeah, okay. No, no, no and and if it's going to if it's going on for a year What prompted you to come in today? Patient: I mean I have been to a doctor about it before but The union rep at work was saying that his father thought he just had her heartburn but then after about like three years the doctor figured out it was Angina and then I started hearing stories about people with the stomach aches or chest pain and they end up having Open heart surgery, and I'm just kind of worried and Sarah also made me come Doctor: So are you worried as your heart? Patient: Yeah Yeah Doctor: Yeah, okay. I want to ask you some more questions just about the pain that you're having I just want to get some more background information in your health overall Patient: Sure. Yeah, so have you had any other medical problems that I need to know about? Patient: No, I've always been healthy Doctor: Okay, so high blood pressure diabetes anything like that Patient: no any other problems with your heart in the past Patient: Nope. No, have you ever had any investigations for your heart? Patient: Not at all Doctor: And what about family history? Has anybody in your family had any heart issues? With their heart? Patient: No. I thought your uncle had heart problems Family Member: No, that was not his heart. That was his stomach and his back Patient: Yeah, I thought it was heart. You know what? I'm gonna text your mom and ask her. Family Member: No, I'm sure not his heart Doctor: Okay, any other medical problems in the family? Patient: Not medical. No, not really Family Member: Your mom has diabetes and your sister has thyroid problems, right? Doctor: All right Okay, okay bill you said not medical what other kind of problems do they have Patient: oh My dad and my brother were both heavy drinkers and smokers. Doctor: Okay. Yeah, I understand. Do you drink? Patient: No hard hardly ever. Well, I mean I will get a bottle of beer Rarely, but I usually don't even finish it Family Member: Yeah. Yeah, he doesn't drink mud that much only when Socially when we are watching some games Doctor: Yeah, okay. And did you used to drink more in the past? Patient: I would say once or twice per week, but I mean watching my dad like that When I was a kid didn't make me too eager to pick it up. Doctor: Yeah. Okay. What about cigarettes? Patient: Yeah, I smoke but I don't smoke nearly as much as I used to. Doctor: Okay, good. Good. How much do you smoke now? Patient: Maybe five a day. Doctor: Yeah Okay, how much did you smoke then? Patient: About a pack a day. Doctor: Yeah pack a day since what age Patient: 16 16 Really? I thought you were much older than that Doctor: Yeah, um, what about any recreational drugs that I need to know about any uh, any substance use? Patient: No No, we don't touch those kind of stuff. Doctor: Yeah. Okay. And any medications, uh that you take other than Tums? Patient: Uh, I take sometimes I take Advil. Doctor: Yeah, sure. Okay. All right about how many would you take a day? Do you think? Patient: I might take one or two a month Doctor: Okay, one or two a month. All right. So, um any other medications? Patient: Nope. No, any allergies? Patient: Nope You mentioned a union rep. Uh, where do you work? Patient: I'm at the Molson Bottling plant. I'm floor manager. Doctor: Yeah. Okay. You have any family in town? Patient: I got my parents in Vancouver and I got a daughter in Pittsburgh And of course my wife Sarah Doctor: Yeah, okay. And is your daughter is that Sarah's also? Patient: No, my old girl, uh girlfriend. Um, she didn't like Canada. So she left before my daughter was born I didn't know she was pregnant and I have never met her Doctor: Your daughter? Patient: Yeah. Doctor: Okay. What's her name? Patient: Uh, Georgina after my mom Doctor: Yeah, and uh, do you have any contact with your ex-partner then? Patient: Yeah, she she writes on holidays or those stuff and I actually got a letter from my daughter She wants me to come to her graduation. Geez Doctor: Yeah. Okay. How do you feel about that? Patient: Oh, I think, uh Things are getting out of my hand. I mean, I I want to go Uh, I mean, I never met my daughter. Uh, How how cool a girl is that to invite that she's never met? to her Or her graduation and I don't know if I can afford to go Doctor: Okay, what's going on with the finances or what what's the concern right now? Patient: Uh, yeah, I mean, I'm in a bit of a hole right now Doctor: Okay. Um, can you tell me about that? How come? Patient: Uh, I got a bit of habit, I guess, uh problem gambling Doctor: Oh dear, okay. So how much are you in the hole for? Patient: Uh, i'm trying to pay off my visa They took that away from me I'm trying to pay off a couple of small loans from a bank That I defaulted on I just can't seem to catch up. Yeah, I mean if My numbers come in I will be set up up until then. I'm a little screwed Family Member: Don't worry, I know all about it and i'm gonna help you out but his gambling Should I leave the room so that you two can talk alone? Patient: No, honey, please stay, you know all about this. Uh, anyway Doctor: Okay, okay, so what what do you play? Patient: Um, primarily I play I play slot machines Doctor: Okay, so let's talk a bit about that bill this I also want to make sure That I talk about the reason that you're brought here, which is a chest pain. I realize you're having That and there are a couple more questions. I want to ask you about if that's okay Patient: Yeah, sure. Sure. Have you had any weight loss at all? Patient: No, I think it's the same I'm not sure. Uh, I don't think so. I mean, uh, no I haven't been eating at all Doctor: okay, so, uh, is that uh, because you're not hungry or you're worried about uh, it's going to make the pain worse at all or Patient: It's just uh, I have been going to bed late i've been waking up early sometimes I will go for a walk in the morning so To see if I can beat the fatigue. I also just grab a cup of coffee before I leave I'll have something for lunch, but uh, then i'm going straight to the casino after work Doctor: Okay, and then so i'm I having usually a hot dog while i'm walking home at night Doctor: Okay, um, are you able to sleep at night? Patient: Yeah For four five hours when i'm home Doctor: Okay, any changes in bowel habits have you noticed Patient: No that I noticed no no vomiting at all Doctor: No, sometimes I feel a little sick to my stomach, but I haven't thrown up Doctor: Okay, do you get a sense that you're sort of an acid taste in the back of your throat? Does that ever happen? Patient: Yeah Doctor: Okay, and um any any weight loss Patient: Uh, like I said, I don't know. Doctor: Oh, right. Sorry. I think I've asked you that so Any dark stools or black poop like like my pants black? Patient: No Doctor: No, um, do you live in a house or apartment? Patient: We live in an apartment. It's just a little place. It's about all we can afford right now Family Member: Do you think you can do something to help my chest pain? Doctor: Yeah. Yeah, I think so. Um, I have a bit of sense of what might be causing it Um, it sounds a little bit like you're having uh some heartburn Patient: Uh, that's uh what my union reps dad said, uh, he had but It turned out to be angina. Doctor: Yeah. Yeah So yeah, there's a couple of things, uh that make me think it's not angina but in a guy your age I think it's worthwhile to do a baseline tracing of your heart just to make sure And i'm not saying it's coming from the food pipe It's and it's coming from your heart But I think things that make me think it's less likely to be your heart is how long it lasts The fact it comes on with meals. It doesn't sound like it's related to exercise uh, you know, do you have any shortness of breath at all with this or Patient: No Doctor: yeah, okay like radiation. Does the pain go anywhere else or is it staying right right there? Patient: Sometimes it goes up to back of my throat Doctor: Okay, so, you know those kinds of things make it sound like it's from heartburn but um I I hear your concern and other people have been told this and they found out later something else, right? So absolutely, let's rule that out just to be sure but uh, so I think we'll make sure there's uh, That we're ruling these other things out, but i'm truly not worried about your heart to be honest Patient: Okay. Doctor: Yeah, but I definitely think we should start some medication just to help. I think heartburn Uh that it is heartburn and we'll make sure that we don't have any bacteria in your stomach that could be causing this Making it worse. So there'll be some blood work that we'll do um Patient: Okay. Doctor: Yeah, and so some other things, uh that you can do lifestyle wise we can talk about that. So Like when you're eating and drinking I think might be contributing to it So changing a diet may go a long way in helping with these symptoms And I think it's worthwhile starting medication now as it sounds like it's affecting your life quite a bit, right? You're uh starting to Patient: yeah Yeah, for sure Doctor: And so, you know the bigger picture though that i'm noticing which is why i'm spending a lot more time talking about this Um, and it sounds like you're just under a lot of stress, right? Patient: Yeah I just can't seem to get things under control Doctor: Yeah, okay. I get it Oh, I got to do something about this I got to fix things up Family Member: Yeah, and it sounds like you've got really great support with sarah, right? Patient: Yeah, I try to help as much as I can. The only thing is I work night shifts And i'm a nurse at the local retirement home So i'm not there in the night times Patient: Yeah, our schedules don't always line up And I don't really have anybody here I mean I used to go to the bar with the guys at work And then I would start playing the slots. They would come to talk to me and I just couldn't talk If I was in the zoom uh, I can't be bothered and I some Most of the guy won't talk, uh to me anymore Patient: Okay, my union rep is standing up for me As much as he can but he can only do so much too Doctor: Yeah, I get it. Are you worried your job's in jeopardy at all? Patient: I've been coming in late sometimes and i'm i'm about the only guy left on the floor that smokes Um, the smoking area is out outside of the grounds and I keep getting caught a cut of property when i'm Supposed to be working Patient: Okay, so management's been riding me and my union rep said i'm just Turning into a train wreck So I don't know how secure my job is anymore. Doctor: Yeah Got it. Okay. So listen, do you think you have a gambling addiction? Patient: I know I I can't I can't seem to stop. I don't know. I I mean, I it's like a lifestyle choice, isn't it? uh, isn't Something I can just turn off Can you Patient: I don't know Sure would like to I I mean they are Offering over time right now I could get out of this hole if I took it about uh, every time I think about staying late I get all uh Twitchy because I I want to be uh heading to the casino Family Member: I had no idea it was so bad, honey Doctor: Yeah, bill it sounds like the gambling is something that's causing you a lot of problems right now It sounds like from what you've said, it's going to be hard for you to stop without some help. Does that does that sound fair? Patient: Yeah, I think so. Yeah Doctor: I mean the most important thing is that you acknowledge that and then the next most important thing is for uh Getting some help for it, right? And so the good news is there's gamblers anonymous and you really have the support of sarah. So Patient: Yeah Family Member: Yeah, yeah, and I'm you know, and there's meetings and groups you can go to through a program similar to aa It's a 12-step program for stopping, uh gambling Patient: Yeah, yeah, yeah, I know a it certainly helped my dad Doctor: Yeah, and you know you come from a family that has had a tendency to you know, have struggles with substances, right? So certainly gambling it's not alcohol But you know there's different theories as to why people run into trouble and are addicted to things be it alcohol gambling cocaine Whatever it is so there's some things that uh are kind of bigger than you and it's probably worthwhile to seek some help because It may not be something you can do all by yourself And i'm concerned that it's not only affecting your health and you're having you know, some symptoms with chest pain I'd like to start sorting that out today, but i'm also concerned as uh Are you I think that the effect it might affect your job and your ability to go and see your daughter's graduation You know some financial impact Um, and you mentioned, uh that it's in the summer or the spring this graduation Patient: Actually she's graduating in four months Doctor: Okay. Yeah. So do you think there'd be a short-term goal we could work towards maybe you mentioned some overtime Patient: Yeah Doctor: Yeah, is that possibly a way out of this hole? Patient: Yeah, yeah, um, would you be willing to come back and meet with me? Patient: Sure. Doctor: Okay. So, you know we can talk about more then and we can get you connected with some of these groups that I mentioned Um, I do want to examine you today though Patient: Sure. Doctor: Yeah. So, uh, because I know you're having chest pain. I want to have a listen to your heart and lungs Let's check your blood pressure. I'm just gonna have a check your tummy your abdomen there Uh, we talked about blood work and I think that's worthwhile Maybe meeting with a dietician right to discuss some changes that you could make and help with the diet to help with the pain Patient: Okay, okay. Family Member: Yep Oh bill your mom just text me back. Uh, and it says uncle had problems Back problems, but not his heart Patient: Okay. Doctor: Yeah. Yeah, so have a seat up on the bed. Um nurse already. Yeah, great No nurse already took your blood pressure. So 130 over 80 your weight was 75 kilos Um, you look well, you're not in any distress. No shortness of breath. You look hydrated Head neck exam is normal. Let's have a listen to the chest here. Um, Clear in all lobes s1 s2. I don't hear a murmur No pain with palpation and the sternum or ribs Um, you know, the abdomen is soft And no lesions noted no hepatosplenomegaly No, no enlargement Does everything seem okay? Patient: Yeah, so far nothing abnormal on the exam, you know, I think we covered a lot today So let's start you on some medication for heartburn see if that helps Here's a prescription for period 20 milligrams. We can take it for four to eight weeks Um, I need to see you in a month just to make sure all is well Let's do some blood work. We'll do the ecg to make sure that is all okay I want you to consider medication for stress and gambling and that may help take the edge off things And then I want to see you in two weeks, right? So i've given you a script for the dietician and I believe your drug plan may pay for that um Here's names for gambling anonymous locations and other resources So i'm just giving it to you in case you want to look at them But we can talk about in a couple of weeks when you come back in so You know, i'll see you in a couple of weeks and sarah lovely to meet you. Thanks for sharing bill I know this wasn't easy. So, uh, really appreciate you coming in today guys Patient: Thanks. See you soon. Family Member: Thank you