Sent 02/23/2026 12:10:21, Page - 32

FRASER HEALTH AUTHORITY Consultation
HOLAND, MARK THOMAS
RC03030788

2. LACTOSE INTOLERANT.

FAMILY HISTORY
Mr. Holand does not have any significant family history for Gl tract malignancy
or inflammatory bowel disease. His maternal grandmother had colon cancer.

SOCIAL HISTORY

Mr. Holand resides in New Westminster with his wife and his daughter. He works
in signals and communications for the Canadian National Railway. He currently
smokes 4 cigarettes a day and reports that he has been smoking on and off since
ihe age of 18. He reports that he cut back significantly approximately 10 years
ago. He drinks approximately 5 alcoholic beverages per week (beer or cider).

He smokes cannabis 1 to 2 times a week.

PHYSICAL EXAMINATION
Blood pressure 107/63, heart rate 62, respiratory rate 18, O2 saturation 99% on
room air, afebrile.

On general inspection, he appeared comfortable at rest and was not noted to be

in any acute distress. He was notably pale.

On focused Gl examination, his abdomen was soft, nontender, and nondistended. He
had no palpable masses or organomegaly

On focused cardiovascular examination, he had normal $1, $2 heart sounds, and
there was no evidence of any extra heart sounds or murmurs. Notably, his chest
pain was not reproducible with palpation.

On focused respiratory examination, he was noted to have good air entry

bilaterally to the bases with no evidence of crackles or wheezes.

Labs: White blood cell count 17, hemoglobin 121 (109 on presentation),
platelets 236, neutrophils 14.8. Troponin 38, INR 1.1. Sodium 139, potassium
43, chloride 106, bicarb 24, BUN 5, creatinine 121, eGFR 63.

ECG demonstrated sinus bradycardia and no other abnormalities.
COVID pending.
H pylori serology pending.

IMAGING
No significant imaging.

ASSESSMENT AND PLAN

Mr. Holand is a 43-year-old gentleman who is otherwise healthy. He presents
with an approximately 5-week history of central substernal chest pain (cardiac
workup was negative on March 5, 2022) and a new onset of hematemesis and
hematochezia beginning early this morning with a background of chronic
significant NSAID use (naproxen for migraines and muscle relaxant plus
ibuprofen/muscle relaxant plus aspirin combination for substernal chest pain).

Mr. Holand had a notable drop in hemoglobin (noted to be 144 on March 5, 2022,
during his presentation to the emergency department and noted to be 109 on
presentation today) as well as a clinical picture that is in keeping with a

likely Upper gastrointestinal bleed secondary to query NSAID use for which he
requires an esophagogastroduodenoscopy for further assessment and

. Meditech Report ID: 0803-2911
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