Transcript

Patient: okay great okay so it was also the blood work right for everything like cholesterol, blood sugars, all my vitamin levels, all the things like the full full pound Doctor: okay let me just see when yes you are due okay so we will order your routine blood work including cholesterol, blood sugar, liver and kidneys okay and also thyroid stuff like that Patient: yeah we can add on thyroid great and then I wanted to check my blood pressure and can you prescribe now that I'm 55 I'd be 56 next year the shingrix shot Doctor: yeah I can so it's recommended over the age so you oh yeah it was prescribed back in 2019 but yes so the shingrix is recommended over the age of 50 to help prevent shingles there's also some interesting research that it helps reduce stroke risk and dementia risk dementia by about 34% which is fantastic an added bonus it's not covered by the government where we can give it to you free like in our office here until the age of 65 however we can write its prescription do you have third-party insurance Patient: I do but doesn't cover anything so it's okay I my husband he has a prescription as well so Doctor: okay yeah absolutely I certainly recommend it double-check with your I'm gonna print it so the pharmacy doesn't start like filling it for you that we can bring to the pharmacy and they can fill it when you're ready yeah and then check your insurance though Patient: okay my insurance is I do cover this I did my fit test and it was fine which is great my husband did his fit test and it came back up normal there's blood in the stool he had to colonoscopy Doctor: okay so I do the fit test every year right where is it every two years Patient: every two years okay so you know I think I'm probably good until after the next one Doctor: let me check when you're due I just did it oh you just did it okay the big over you know you get the results right yeah let me double check them the fit over captures though so if there's gonna be it over captures right rather than under it doesn't miss things potentially so um if there is often like the fit will be abnormal but then we say for a colonoscopy and it's normal well here's three really sizable polyps again which is why he worries some right what he had the fit test there's blood in the stool he went for the colonoscopy they've got three pretty sizable polyps polyps and then luckily they said they were pre-cancer so he has to go next year for another Patient: okay okay so I'm my kid back fine so I'll wait until yeah I guess it'll be 57 because I just did it at 55 and it was fine so here is and then I guess when do we do like a breast exam and all that again Doctor: okay let's see I just wanna have a full tune up you know okay so in terms of okay the fit test was just negative in July so you're up to date for that and then your so that will be in two years but in July like you mentioned we gave the prescription for the Shingrex we'll order the blood work and then the mammogram you are I believe actually do let me double check that unless we didn't I'm just gonna check your chart because it was last in 2023 yeah I remember this yeah so you're due okay so we're gonna order that now can I send it to Trillium where you've had it done before is that oh that's an okay spot to get it Trillium look over here across the street well it will go in here it will go to all Trillium sites like so Credit Valley Trillium across the street and Betty Wallace at Shureway and they'll decide based on your address the best location for you Patient: okay yeah sure is that okay yeah and then they'll basically send they'll call me and tell me they either they often will send you a letter and if it's not a good time then you can Doctor: oh perfect yeah actually the last time I did it it was actually near my home oh let me see my home okay on Kipling and Dixon like there's a clinic there and they do Patient: Oh Richmond Gardens yes okay we can send it would you mind cuz that's fine and as long as they're through the OBSP which they are which is the Ontario Breast Screening Program Doctor: yes okay let me see if I can find them in here okay Richmond Gardens I just looked up the last report yeah that's where I did the last one cuz I know I did it once during COVID and then a couple of years later so yeah so obviously now because it's every two years now it's every two yeah unless you have a reason to do it every year which I'm looking you did not yeah I'm just seeing okay we don't tend it doesn't look like we have their ultrasound rec specifically for them so what I'm gonna do is I'm gonna order it on the hospital rec and then you can bring it there when you go to book your appointment you can also call the OBSP line the Ontario Breast Screening Program line Patient: okay and then you book it at the place of your set of your site you actually don't need the requisition Doctor: oh yeah yeah Ontario Breast Screening Program call them and have the place you want to go to as long as they're an OBSP site which is Richmond Gardens I'm going to you don't actually need it though but I will so that'll remind me so I'll have that yeah the shingles and I'll have the blood work perfect yeah okay good so I will do that but I'm not gonna send to Trillium if you don't want to go there okay and you don't actually need the rec but it's good to have it as a reminder so what you need to do is call the OBSP book it through them at your choice of your site of choice which is Richmond Gardens Patient: okay okay because yeah we don't have their specific requisition in our in our program Doctor: okay not a problem yeah I think it I think because during COVID it came in the mail it still does it still does I'm surprised you didn't get it that's through the government it should come in the mail so that's yeah no but they should they should be yeah there was a strike during but they should be sending you in the mail as a reminder so it's interesting or even with the appointment but they didn't so I'm glad you brought it up so we're ordering it now okay because you are due okay so let me print that for you I've already printed the shingrax we've done the mammogram and then the blood work for everything Patient: okay the blood work requisition is good for six months you do not have too fast it's gonna be blood and urine okay just to be a total result and that'll do everything like yeah cholesterol and whatever because yeah while we were tracking that kind of went down a bit Doctor: yeah so it's gonna wait three months I'll wait till after Christmas and then I'll make all the sugars just do it within six months so doesn't expire and then it doesn't have to be fasting okay and it's good at any life lapse Patient: okay okay I'm just gonna make a note to keep an eye out for the mammogram yeah just know you can book anytime you are due Doctor: okay yeah and then your next cervical cancer screening is in 2026 just so you know in March though Patient: okay yeah mm-hmm mm-hmm okay and you could wait if you're due in March to take the idea then I just want to sort of see how I feel Doctor: that's fair I feel great then when I have to do my cervical exam I might be I might be calling you very recently so if I want if those three months doesn't feel great then we have to do the cervical exam you guys can then I wouldn't be we would talk about it at that point if you're still having bleeding like at 55 after the Mirena we might start with an ultrasound and just take a look and see what's going on first before doing putting in a new IUD Patient: okay but first we wait and see what happens I would expect your period should be done Doctor: okay so let's see okay okay let me so all those are printed out yeah and I'll give you a gown just one second just make sure did you have your flu shot this year Patient: I had it I was here just not too long ago with my daughter and she had it as well Doctor: oh and I got we gave it we gave it to you you guys gave it to me okay actually okay it's just not in here so I'm just going to put it was an October flu shot October 27th yeah it just wasn't we just need to oh yeah I see it now okay and I don't like COVID shot in November okay through the pharmacy at the pharmacy excellent perfect perfect perfect so you are up to date then oh today fantastic yeah okay let me just get a gown here okay so this gown you can just have um yeah bottom bottom off okay can leave your socks on just bottoms off and then you can be sitting this way legs over this way don't be lying down yet we'll get you to lie down right when I come in okay alright perfect that is definitely let me just make sure I have everything I need and I'll just go get the kit I'll knock before I come back Doctor: okay can you feel the IUD strings have you felt them? Patient: I don't know, at the beginning I felt them and sometimes during intercourse I feel like some occasional twinge Doctor: okay so you haven't felt them recently you have at the beginning yeah so we'll aim to get it out today the only issue is sometimes the strings after time become coiled up so if we don't have access to them we have a few tricks that we can try and get them out the only issue sometimes is it become coiled up we can't we can't reach them. Patient: So what does that mean if you can't do that? Doctor: We will have a discussion if that happens but likely that means you have to send it to gyne because they have to do a little procedure to take it out it's rare usually we can take it out no problem Patient: come on Kim I have faith I just want to know now just have to have the strings should be fine Doctor: okay okay all right I haven't really felt like went to go look and feel for the strings exactly okay you know it's pretty thick down there so I don't really know what's going on okay I will knock but I'm just gonna go get the kit I'll get all the forms that I ordered for you oh you wanted your blood pressure checked let me see if it's been you have you been checking it at home Patient: no Doctor: okay yeah it's been exactly before we do this procedure then let me let me check your blood pressure now. Patient: I might be stressed. Just a little bit of it. Doctor: Okay you're there perfect I'm just gonna go grab it we'll check it oh it will be fine okay this is a thin top so we can go over top okay both feet on the ground nice and flat feet try not to move try not to talk machine's a little finicky take it one more time this is a little high I'm not bad just the bottom number is slightly high in the 90s but the top was okay but we always take two oh just one second okay good the bottom numbers come down into 135 over 86 um it's probably higher than your normal it's okay we want it under 140 over and under 90 135 over 86 it's gonna be higher here than it is do you have a blood pressure machine at home yeah keep an eye on it at home okay check it once or twice a week first thing in the morning or right before bed take it twice only write down the second reading if you start to see that most of the readings are in the 140s or higher or the bottom number is in the 90s or higher let me know exactly okay but today it's okay especially for an office reading it's fine Patient: okay it's just yeah it's it's uh this is a follow-up they should make it so you have it and after eight years it just dissolves Doctor: you might be on to something you might want to pattern that idea except if you the problem is if it just dissolves and you don't know when and you're younger and you're using it for birth control you can see where there's just dissolves there you go we can create a pattern together Patient: okay yeah there you go Doctor: okay I am going to leave the room grab the device I'll knock before I come back in the blood pressure is fine those are your three forms of shingles okay that is a reminder to call the OBSP Richmond Gardens was the place and then that's your blood we're good for six months that's right get it all done exactly Patient: yeah okay so now I will get you to swing around so that you feel like your bum is all the way off the edge yeah one more there you go that's perfect just like that don't mind I'm just going to show you that's where the heel is right there yeah there you go might be just like just to help with the comfort sure okay and then just let your knees go to the side as much as you feel comfortable and make it as comfortable as it can be Doctor: any dryness any vaginal irritation Patient: no it's actually the opposite okay it's like it's not really about I mean I definitely having like leaking Doctor: okay so like in terms in terms of discharge no pressure okay so that's this little pressure pressure for a second breath into your nose eight seconds out through your mouth so sometimes okay I can see strings they're just a bit oiled I'm just gonna have to one two Patient: oh my god we're done oh my god that was terrible Doctor: oh but you're done does it look different when it comes out like is it all like rusted out Patient: no it's not rusted out I don't like to scare people too much but it is a weird sensation I know so the thing is it's you have to bring it through it has to come through your eyes right and so the way it is it's like it's a it's a tea so what imagine so it's flat but then the tea part has to pull through at the end so it's it's it's a weird sensation but if you've had it in quite a while Doctor: yeah but it's what I remember having to put in and I was like oh my god yeah before she put it in because I had the just put it in yeah actually did a before doing that did you get numb no she did a biopsy oh yeah and then like you know basically they snip a piece of I know I was like oh no I'm like you didn't worry was gonna be happy the block the biopsy there yeah this isn't so much people as it feels extremely uncomfortable oh it's a very weird feeling right I told you it was a weird feeling it's done it's a you're done let's see what happens everything looks fine I'm gonna leave the room you're gonna get changed and you are free to go all your stuff now on your end to take care of you Patient: okay thanks so much Doctor: of course but you are holiday you too and then you're free to go like I said after this Patient: okay okay all right you take care Doctor: thank you okay bye now