Mar 12, 2026 11:58 To: +16042339777 Page: 35/46 From: Foremed Medical Clinic Fax: 16043985614

FRASER HEALTH AUTHORITY Emerg Note - Complex
Royal Columbian Hospital HOLAND,MARK THOMAS
RC0437506/25

The ear canals were normal. Cranial nerve examination was normal. There was no carotid bruits.
Renee and Webber tests were normal,

I discussed the case briefly with Dr. Zahabi from ENT. Dr. Zahabi does not think this is ENT of origin
given the audiology tests and the year examination were completely normal. The ENT speciatist
suspect that the noisy environment might have triggered his migraine headache leading to the
patient's symptoms. both ENT and Neurology does not think outpatient follow up is warranted at this
point.

On reassessment at 2145 hours, the patient's migraine headache improved. He is frustrated with the
worsening symptoms and the persistent migraine. He asked for a prescription for sumatriptan. He
agreed to a trial of prednisone 50 mg once daily for the next 5 days. I gave him a 2 weeks' worth of
Pantoloc 40 mg once daily to protect his stornach while he is taking the prednisone. I have suggested
him to follow up with his family doctor after the completion of the prednisone.

Medications and Allergies

Allergies:
Allergies
Allergy/AdvReac [Type | Severity Reaction | Status | Date / Time
No Known Drug Allergies | Alergy = Unknown = Not Verified | 25/01/2026 16:41 |
| | _ Applicable _| |
_ LACTOSE | AHtergy Unknown | Unknown | Uncoded | 25/01/2026 16:41 |
Exam
Physical exam
| Glasgow Coma Scale total score 15/15 [30/01/2026 20:20
_Glasgow Coma Scale total score 15/15 30/02/2026 14:32 0

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Meditech Report !D: 3001-00357 2084

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