Mar 12, 2026 11:58 To: +16042339777 Page: 29/46 From: Foremed Medical Clinic Fax: 16043985614

FRASER HEALTH AUTHORITY Emerg Note
Royal Columbian Hospital HOLAND,MARK THOMAS
RC0161840/25

Medications:
Bilastine 20 mg daily
Sumatriptan 25 mg PRN

Physical exam:
BP 100/62, HR 50, RR 18, Temp 36.7, O2 sat 98% on RA
Orthostatic vitals: sitting 97/61, standing 100/62

Appears well, no acute distress

PERL, EOM full, face symmetrical, equal palate elevation, tongue is midline
Normal Si S2, no EHS or murmurs, radial pulses regular bilaterally
Breathing comfortably on RA, chest clear

Abdomen is soft, non-distended, epigastric tenderness

Investigations:

WEC 5.7

Hb 160

Liver function, kidney function, lipase within normal limits

ECG: Sinus bradycardia

Holter 18/05/2025:
Normal Holter Monitor
Low average heart rate of 49 beats per minute

Assessment and plan:

The cause of Mark's abdominal pain is not clear. There are no signs of active bleeding ulcers, given
his Hb is normal and there is no hemoptysis or blood in the stool. We consulted GI who advised clear
fluid diet times 24 hours with abdominal pain, repeat CBC in 3 days, H pylori screening, and
pantoprazole 40 mg BID. We referred him to gastroenterology, Dr. Atkinson, for further management
and consideration of out patient scope; per GI request he has been CBC. With regards to his 2-week
history of presyncope, we are reassured by the results of his orthostatic vitals and Holter monitor. He
will follow-up with his famliy doctor for further management and to discuss the results of his out
patient labs.

Bianca Te MSI3
For Dr. K Eppler

Staff note: Patient reviewed, assessed and examined. 46-year-old male who had duodenal ulcer

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Meditech Report iD: 1905-00211 3o0f4

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