You enter the exam room to meet Mr. C He is accompanied by his wife.

He greets you cheerfully, and appears well. He tells you that with the cold weather over the past few months, he has noticed his fingers and toes become painful and blue after shoveling snow. This resolves after a few hours.

On further questioning, he notes that he has been somewhat more fatigued in recent months as well.

His wife also notes that the whites of his eyes seem to be yellow lately. She tells you Mr. C stopped drinking years ago, but she worries this could be related to his prior heavy alcohol use.

You know from reviewing his chart that Mr. C has been anemic for the past year, with a hemoglobin of 9-10. Prior to that, his counts had been normal.

What else would you like to know, while you are in the room with Mr. C and his wife?

Alcohol use disorder: 10 beers a day since age 27, quit 10 years ago. Colonic polyps on colonoscopy 5 years ago.

Notable for mesothelioma in his father, otherwise unremarkable.

He works as a truck driver, and lives with his wife and 6 children.

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