Diagnosis: Medcan

Geoffrey Collins
68 years old
St. Catharines, Ontario
Retired Engineer
Handling doctor: Dr. Lorne Greenspan

The problem

Geoffrey Collins is a 68-year-old retired engineer who co-developed a patented bubbler for icebreakers that reduced hull-to-ice friction by 60%. He lives in St. Catharines, goes to the gym three times a week, and considers himself in good physical shape. But early this summer he noticed he didn’t feel like himself. There was a tiredness that progressed to an overall lethargy in mid-August. “You know what,” he said to his wife. “I just don’t feel good.” He arranged an appointment with his general practitioner, who diagnosed him with slightly decreased thyroid levels. But the thyroid medication didn’t affect Mr. Collins’ lethargy. He huffed and puffed after a flight of stairs. Even talking for a while would leave him out of breath. Finally, a friend suggested Medcan. And Mr. Collins replied, “What’s Medcan?”

The appointment

Nurse triage team member Jennifer Williams took Mr. Collins’ initial call to Medcan. She arranged for Mr. Collins to have an appointment with Dr. Lorne Greenspan, who saw Mr. Collins along with his wife and daughter on Sept. 12. “What concerned me was that Mr. Collins, usually an active man, had a sudden decline in vigor, energy and exercise tolerance,” says Dr. Greenspan, who arranged for Mr. Collins to conduct a cardiac stress test on a treadmill while Dr. Greenspan stayed in the room to witness Mr. Collins’ response. “I didn’t last a minute before I was puffing and panting,” recalls Mr. Collins. Concerned, Dr. Greenspan stopped the treadmill session and decided to explore Mr. Collins’ condition with a series of blood tests to gain a more accurate picture of what was happening inside Mr. Collins’ body.

More questions

What could impair Mr. Collins’ cardiac and respiratory function so dramatically? The problem could have resided in any number of the body’s systems. The shortness of breath, weakness and fatigue might have been a symptom of pneumonia. But Mr. Collins didn’t have a fever. Could the problem have been pericardial effusion, or liquid around the heart? Or a series of pulmonary emboli—clots in the lung arteries? Because Medcan has an in-house laboratory, Dr. Greenspan obtained Mr. Collins’ blood test results within a few hours, while Mr. Collins still was at Medcan. The results helped Dr. Greenspan diagnose Mr. Collins with primary hyperparathyroidism, a hormonal disorder. But that didn’t explain the impaired lung function. Also, Mr. Collins had a troubling result to his high-sensitivity C-reactive protein blood test (hs-CRP), suggesting that there was a significant pathological process occurring.  At that point, Dr. Greenspan decided Mr. Collins needed to undergo more sophisticated investigations available only at a hospital. He contacted the triage team at St. Michael’s Hospital Emergency Department and told them he was sending over Mr. Collins, then provided Mr. Collins with a letter that summarized his case for St. Mike’s ER docs.

The solution

At the hospital, Mr. Collins underwent more tests, including a CT-angiogram that showed numerous life-threatening blood clots in his main pulmonary artery and the segmental branch arteries in the lungs. If left untreated, the clots could have blocked the arteries, stopping blood flow to the lungs, leading in turn to a lethal cardiovascular collapse. Mr. Collins’ medical team injected blood thinners into his stomach, which quickly made a difference. Suddenly, he could take a deep breath again. Over the course of another week in hospital he received many more injections, as well as a prescription for the oral anticoagulant known by the generic name warfarin. He also received blood pressure medication for his high blood pressure, and an appointment with an endocrinologist to address the endocrine disorder Dr. Greenspan also diagnosed.

The follow-up

Mr. Collins has been feeling so much better that he recently had his blood thinner medication decreased to 4 mg per day. He’s back on the treadmill for regular 30-minute walks, and recently completed the equivalent of the Medcan stress test without difficulty. “I feel great,” says Mr. Collins, whose blood pressure now is a healthy 120 over 78. He also visited his general practitioner to give him an update. Mr. Collins confessed to the doc that he felt a bit sheepish—as though going to Medcan amounted to going over the general practitioner’s head. The doctor told him not to be silly. “If you’d come back to me,” the doctor said. “I could have maybe got you an X-Ray the next day, but that CT-angiogram might have taken you three months. You probably saved your own life by going to Medcan.” The lesson for Mr. Collins? If you sense you have a health issue, go see someone about it until it’s addressed. Meanwhile, for Dr. Greenspan, Mr. Collins’ case illustrates the importance of beginning each patient examination with a clean slate. “At times, when our patients already have seen a doctor about a problem,” Dr. Greenspan says, “there’s a tendency to say, well, that’s already been investigated. Here, we pride ourselves on starting with a clean slate. We’re the ones who take another look.”