Have you ever been hospitalized overnight for anything? Any operations? Why? Yes, in 1978 for bladder reflux surgery. |
Describe your problem – if you are having any gastro-intestinal symptoms, or say “none”. Cramping in lower abdomen, alternating between diarrhea and constipation, red blood in stool, gassy and bloated abdomen. Sore to touch and fatigue. |
Do you smoke? How much and for how many years? Quit? For how many per year? Yes, quit approximately 2 months ago. Smoked since a teenager. |
Do you drink alcohol? How many beers/glasses of wine/drinks of liquor a day or a week or a month? Please reply for each type of beverage. I do not consume alcohol. Never have. |
How’s your appetite? Have you lost any weight recently? How much? On purpose? Still losing? Appetite varies. Hunger to nausea. No significant weight loss or gain. |
Any trouble swallowing? Nausea? Vomiting? Heartburn or indigestion? If yes to any of these, how long is problem present, and how many times a day or a week or a month does it occur? N/A |
Any pains in your abdomen? Please describe – where in your abdomen, constant or intermittent, duration of each episode if intermittent, severity, anything that makes it worse, anything that makes it better? Yes, pain in lower abdomen. Radiates from centre to both sides. Somewhat constant over last two weeks. |
How often do you have a bowel movement (BM)? Daily? Every 2nd day? Solid or loose? Any bleeding? Do you get up from sleep to have bowel movements? |
Any urgency? If urgent, mild, moderate, or severe? Bowel movement can range from daily to every few days. Intermittent blood in stool. Always suffered from irregularity. Do not get up during sleep. |
List ALL medications, doses and reasons for being on them, whether prescribed or not. Not currently on any medications. |
Are you allergic to any drugs? If yes, describe reaction. No |
Please tell me about your family history; anyone with colon cancer or colon polyps; any other kind of cancer in the family; any diseases that “run” in the family? Diabetes on mother’s side, paternal grandfather died of stomach cancer, mother has polyps. |
Do you have heart disease? Lung disease? Kidney disease? High blood pressure? Any other disease? No diseases. |
Do you have sleep apnea? No |
What do you do for a living? Mental Health Community Crisis Worker. |