This is my initial physical exam.

It is my impression that the patient has probable NSAID-induced

peptic ulcer disease. I gave the patient rehem hemocoel all of which were returned and were
subsequently negative. If at a future day, the patient requires increasing dosage of NSAIDs her stool
should be re-examined, and if at any time they are positive, I would proceed with gastroscopy. My
impression was that he possibly had ulcer disease. He was given a trial of Tagamet 400 mg p.o. b.i.d.
He was also given hemocoel cords, which he sent back and which were subsequently negative on
three different occasions. He was also given the cancer society per se on the guidelines for
preventing cancer. He was instructed to eat a high fibre diet. We suggested that he read the “Save
your life diet book.” I discussed with him that, if he did not get to defecate relief it would
appropriate to proceed with gastroscopy.