Tuesday, June 30, 2015

Breast Cancer

Vocabulary
mammogram [mam-uh-gram]
metastatic [muh-tas-tuh-sis]
menstrual cycle [men-struh l] [sahy-kuh l]
mammogram [mam-uh-gram] 
Paget's disease \pa-jəts-\ [dih-zeez]
ulceration [uhl-suh-reyt]  symptomatic [simp-tuh-mat-ik] 






Overview

The first sign of breast cancer often is a breast lump or an abnormal mammogram. Breast cancer stages range from early, curable breast cancer to metastatic breast cancer, with a variety of breast cancer treatments. Male breast cancer is not uncommon and must be taken seriously.



Symptoms

In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:
  • A lump in the breast or underarm that persists after your menstrual cycle. This is often the first apparent symptom of breast cancer. Lumps associated with breast cancer are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
  • Swelling in the armpit.
  • Pain or tenderness in the breast. Although lumps are usually painless, pain or tenderness can be a sign of breast cancer.
  • A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
  • Any change in the size, contour, texture, or temperature of the breast. A reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
  • A change in the nipple, such as a nipple retraction, dimpling, itching, a burning sensation, or ulceration. A scaly rash of the nipple is symptomatic of Paget's disease, which may be associated with an underlying breast cancer.
  • Unusual discharge from the nipple that may be clear, bloody, or another color. It's usually caused by benign conditions but could be due to cancer in some cases.
  • A marble-like area under the skin.
  • An area that is distinctly different from any other area on either breast.



Colon Cancer



Vocabulary
digestive system [dahy-jes-tiv] [sis-tuh m]
Rectal cancer [rek-tl] [kan-ser]
colorectal cancer [koh-luh-rek-tl] [kan-ser]
benign [bih-nahyn]
adenomatous polyps [ad-n-oh-muht-uhs[pol-ips] 
malignant [muh-lig-nuh nt]
tissues [tish-ooz]colon  [koh-luh n]
rectum  [rek-tuh m]
prognosis [prog-noh-sis]
rectum [rek-tuh m]
lymph nodes [limf[nohdz]
chemotherapy [kee-moh-ther-uh-pee]
metastasize [muh-tas-tuh-sahyz]
cancerous [kan-ser-uhs
prostate cancer [pros-teyt] [kan-ser] 
precancerous polyps [pree-kan-ser-uh s] [pol-ips] 

colon cancer [koh-luh n] [kan-ser] 
anus [ey-nuh s]  
symptoms [simp-tuh mz]
Fluorouracil (5-FU) [flohr-r-uh-yoo r-uh-sil[fahyv] [ef] [yoo]
Leucovorin \lü-ˈkäv-ə-rən\
Oxaliplatin [ox AL i PLA tin]
Capecitabine (KAP-e-SYE-ta-been)
Irinotecan (EYE-ri-noe-TEE-kan)

Definition
By Mayo Clinic Staff

Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they're often referred to as colorectal cancers.
Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers.
Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer.

General Information About Colon Cancer




KEY POINTS
  • Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon.
  • Health history can affect the risk of developing colon cancer.
  • Signs of colon cancer include blood in the stool or a change in bowel habits.
  • Tests that examine the colon and rectum are used to detect (find) and diagnose colon cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Overview
Colorectal cancer, or colon cancer, occurs in the colon or rectum. As the graphic below shows, the colon is the large intestine or large bowel. The rectum is the passageway that connects the colon to the anus.
Colon cancer, when discovered early, is highly treatable. Even if it spreads into nearby lymph nodes, surgical treatment followed by chemotherapy is highly successful. In the most difficult cases — when the cancer has metastasized to the liver, lungs or other sites — treatment can prolong and add to one’s quality of life.



Most colon cancers develop first as colorectal polyps, which are abnormal growths inside the colon or rectum that may later become cancerous.



Colon cancer affects men and women of all racial and ethnic groups, and is most often found in people 50 years or older. It is the third most common cancer in the United States, behind only lung and prostate cancers in men and lung and breast cancers in women, and the second leading cause of cancer death.
In fact, it is estimated that in 2013, 50,830 people will die of colon cancer. But the truth is: it doesn't have to be this way. If everyone 50 years or older had a regular screening test, as many as 80% of deaths from colon cancer could be prevented. View more colon cancer statistics.
Colon cancer screening saves lives. Screening detects precancerous polyps and allows them to be removed before turning into cancer. Screening also helps find colon cancer at an early stage, when treatment often leads to a cure. So please, take control of your life and your health – if you’re turning 50 or are experiencing abnormal symptoms, GET SCREENED. And urge those you love to do the same.



Medication
Chemotherapy is the use of medicines to control the cancer's growth or relieve symptoms. Often the medicines are given through a needle in your vein. Your blood vessels carry the medicines through your body. Sometimes the medicines are available as pills. And sometimes they are given as a shot, or injection.
Several medicines are used to treat colorectal cancer. There are also several medicines available for treating side effects.

Medicine choices

A combination of drugs often works better than a single drug in treating colorectal cancer. The most commonly used drugs are:
Hair loss can be a common side effect with some types of chemotherapy. But hair loss usually isn't a side effect of these drugs.


Monday, June 8, 2015

Questions to Ask the Doctor

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The 10 Questions You Should Know
  1. What is the test for?
    Answer:  The test is to find the problems you are having as soon as possible.
    Answer:  The test is to see if your child is anemic.  The test is to check if your child has anemia.
    Answer:  The blood test is to check your antibodies for hepatitis B.
  2. How many times have you done this procedure?
    Answer:  Don't worry.  I have done this many times.
    Answer:  I have a lot of experience with this proCEdure.
  3. When will I get the results?
    Answer:  You will get the results after 4 hours.
    Answer:  You will get the results in about 1 hour.
  4. Why do I need this treatment?
    Answer:  You need this treatment, because your temperature is high.
    Answer:  Your ultrasound is not normal.  We need to perform a biopsy to diagnose your problem?
  5. Are there any other options?
    Answer:  Yes.  You also need to drink a lot of water and get plenty of rest.
    Answer:  No, you need to take the biopsy, and we need your results.
  6. What are the possible complications?
    Answer:  You might bleed a little.  You might bruise.
    Answer:  You might experience swelling.
  7. Which hospital is best for my needs?
    Answer:  The tumor hospital is best for you.
    Answer:  Van Hanh Hospital has everything you need.
  8. How do you spell the name of that drug?
  9. Are there any side effects?
    Answer:  The effects of Ibuprofen are stomachache and hypertension.
    Answer:  The effect of Ibuprofen is bleeding of the stomach.
  10. Will this medicine interact with medicines that I'm already taking?
    Answer:  Yes, this medicine has bad interactions with steroids and Aspirin.
Embed Music Files - Download Audio - June 9, 2558 BE at 4.46.58 P...

Questions to Ask Your Doctor

  1. What do you think is causing my problem
    Answer:  I think that the hot weather is causing your fever.
    Answer:  I think the weather change is causing your fever.
    Answer:  You have Hepatitis B so you may have liver cancer.
  2. Is there more than one condition (disease) that could be causing my problem
    Answer:  Yes, for example, the flu virus might be the cause of your problem.
    Answer:  No, there isn't.
  3. What tests will you do to diagnose the problem and which of the conditions is present?
    Answer:  I will give you a blood test.
    Answer:  I will give you an ultrasound.
  4. How good are the tests for diagnosing the problem and the conditions?
    Answer:  The test is 100% accurate.
  5. How safe are the tests?
    Answer:  It is completely safe.  There's nothing to worry about.
  1. Why do I have this condition? What is the long-term outlook with and without treatment?
    Answer:  You may have the Hepatitis B virus through blood transfer or sexual intercourse.
  1. What are my treatment options? How effective is each treatment option? What are the benefits versus risks of each treatment option?
    Answer:  You can take medication to reduce Hepatitis B.
  2. If my symptoms worsen, what should I do on my own? When should I contact you?
  3. Are you aware of each of the medications that I am taking? Can they adversely interact with the medications you are prescribing for me?
  4. Should we monitor for side effects of the medications that you are prescribing or for their interactions with other medications I am taking? 




Questions to Ask the Doctor 

Tests, such as blood tests or scans
  • What are the tests for?
  • How and when will I get the results?
  • Who do I contact if I don’t get the results? 
Treatment
  • Are there other ways to treat my condition?
  • What do you recommend?
  • Are there any side effects or risks? If so, what are they?
  • How long will I need treatment for?
  • How will I know if the treatment is working?
  • How effective is this treatment?
  • What will happen if I don’t have any treatment?
  • Is there anything I should stop or avoid doing?
  • Is there anything I can do to help myself?
What next 
  • What happens next?
  • Do I need to come back and see you? If so, when?
  • Who do I contact if things get worse?
  • Do you have any written information?
  • Where can I go for more information?
  • Is there a support group or any other source of help?  

Questions to Ask Your Doctor

About Your Symptoms or Diagnosis

  • What is the disease or condition?
  • How serious is my disease or condition and how will it affect my home and work life?
  • What is the short-term and long-term outcome for my disease or condition?
  • What caused the disease or condition?
  • Is there more than one disease or condition that could be causing my symptoms?
  • Should I be tested for a certain disease or condition?
  • What symptoms should I watch for?
  • How can I be tested for a disease or condition, and what will these tests tell me?
  • What tests will be involved in diagnosing my disease or condition?
  • How safe and accurate are the tests?
  • When will I get the test results?
  • Will I need more medical tests?
  • Do I need a follow-up visit and if so, when?
  • Do I need to take precautions to avoid infecting others?
  • How is the disease or condition treated?

About Your Treatment

  • What are my treatment options?
  • How long will the treatment take?
  • What is the cost of the treatment?
  • Which treatment is most common for my disease or condition?
  • Is there a generic form of my treatment and is it as effective?
  • What side effects can I expect?
  • What risks and benefits are associated with the treatment?
  • What would happen if I didn’t have any treatment?
  • What would happen if I delay my treatment?
  • Is there anything I should avoid during treatment?
  • What should I do if I have side effects?
  • How will I know if the medication is working?
  • What would I do if I miss a dose of medication?
  • Will my job or lifestyle be affected?
  • What is my short-term and long-term outcome?

If You Need Surgery

  • Why do I need surgery?
  • What surgical procedure are you recommending?
  • Is there more than one way of performing this surgery?
  • Are there alternatives to surgery?
  • How much will surgery cost?
  • What are the benefits of having surgery?
  • What are the risks of having surgery?
  • What if I don’t have this surgery?
  • Where can I get a second opinion?
  • What kind of anesthesia will I need?
  • How long will it take me to recover?
  • What are your qualifications?
  • How much experience do you have performing this surgery?
  • How long will I be in the hospital? 

Questions Your Doctor May Ask

  Chronic Cough

  • How long have you had the cough?
  • Did your cough start with an illness or a lung infection?
  • Do you cough all of the time, or only during or after activity?
  • Do you cough after meals?
  • What time of the day is your cough the worst?
  • Do you cough up mucus? If so, what color is the mucus? Is it thick and viscous, or is it thin and runny? How much mucus do you cough up?
  • Do you have chest discomfort with your cough?
  • Do you experience difficulty breathing with your cough?
  • Have you had a fever recently?
  • Have you lost weight recently?
  • Do you ever have night sweats?

Shortness of Breath

  • Do you feel you have to work hard to breathe?
  • For how long have you been feeling short of breath, having difficulty taking a deep, satisfying breath, feeling winded, or working hard to breathe?
  • How often do you feel short of breath?
  • Are you short of breath all of the time, or only during or after activity?
  • Do you limit the kinds of activities you do because of shortness of breath?
  • Do you also have a cough?
  • Do you experience wheezing with your shortness of breath?
  • Do you experience any chest pain?
  • Have you had a fever recently?
  • Have you lost weight recently?
  • Do you ever sweat at night?
  • Do you feel 'tightness' more in your throat or in your lungs?

Diffuculty Breathing

  • For how long have you been experiencing difficulty breathing?
  • Are there certain seasons or times of the year that you have difficulty breathing more than others?
  • During what part of the day do you typically have difficulty breathing?
  • Is it worse at certain times than at others?
  • Do you also cough?
  • Do you also feel short of breath when you have difficulty breathing?
  • Do you ever feel like you're choking?
  • Do you feel any nasal discharge in the back of your throat (post-nasal drip)?
  • If so, is the discharge thick and viscous, or thin and slimy? What color is the discharge? How much mucus are you producing?
  • Do you ever experience a gagging or choking sensation?
  • Do you feel like you have to clear your throat all of the time?
  • Have you had a fever recently?
  • Have you lost weight recently?
  • Do you ever have night sweats?

Note: A chronic cough, shortness of breath, or wheezing can be symptoms of serious medical conditions. If you experience any of these symptoms, we recommend that you see a doctor.

Questions Patients Ask Doctors



#1- How many I help you today?
Answer: Tell the doctor why you are there. Does something hurt? Have you been having some unusual symptoms? Are you pregnant? Did you fall?

#2- Where do you feel pain?
Answer: Name the part(s) of the body that is hurting you and when they hurt.

#3- What are your symptoms?
Answer: More specifically, what is going on with your body? What do you feel? Common symptoms: dizziness, cough, stomach ache, diarrhea, head ache, stomach ache, vertigo, constipation, sore throat, sleeplessness, feeling bad, etc.

#4- How long has this been going on?
Answer: How many days or months have your symptoms been going on? Give an estimate if you do not know exactly.

#5- Has the pain been getting better or worse?
Answer: When do you feel the worst? Is it always the same time of day? Does it hurt all of the time? After you do a certain activity?

#6- Do you smoke? Do you take any recreational drugs? Do you drink alcohol and how often?
Answer: Truthfully answer the question. Your answer helps how the doctor makes his/her diagnosis. Also be sure to tell the doctor how often/how much.

#7- Do you have a family history of this?
Answer: The doctor wants to know if something runs in your family. Tell the doctor if your parents, siblings or grandparents had similar ailments. They often will ask you this about a list of diseases; like: cancer, diabetes, hypertension, depression, anxiety, heart problems, etc.

#8- Do you take any medicines or supplements?
Answer: This helps the doctor know if the symptoms that you are feeling are side effects of the medicine or not. Supplements means: vitamins or herbs.

#9- Are you sexually active?
Answer: This helps the doctor know if they should consider pregnancy and/or sexually transmitted diseases in their possible diagnosis.

#10- Have you had any previous surgeries?
Answer: Tell the doctor yes or no. If you have had surgeries tell the doctor what kind and how long ago.

#11- Does it hurt when I push here?
Answer: During a physical exam the doctor will touch or push on different parts of the body. Tell the doctor if that area hurts when touched or not.

#12- Are you allergic to any medicines?

Answer: If the doctor prescribes you medicine they want to make sure you have not had a bad reaction to it in the past.

Tuesday, June 2, 2015

Script - Headache

Patient:   Doctor, I am  really sick! 

Doctor:   Tell me what you  feel.

Patient:   My head hurts. I have a constant headache!
 

Doctor:   Do you have a  fever?
 

Patient:  No.  But my back hurts too.
 

Doctor:   Are you sleeping well?
 

Patient:  No, I wake up every hour. The pain is there all the time.
 

Doctor:   Do you have pain  in your stomach?
 

Patient:   Some of the time.
 

Doctor:     Do you have pain in your neck?
 

Patient:    No.
 

Doctor:     Does your throat sting?
 

Patient:    No.
 

Doctor:     Are you coughing at night?
 

Patient:    No.
 

Doctor:    I understand.  I  think I know what the problem is.
 

Patient:   Will I have to have blood tests or x-rays?

Doctor:    No, that won't be necessary.
 

Patient:   Good. 
Doctor:   Just take two of these tablets every four hours for a week.  You should feel better in a 
few days. You don't have to worry at all. 
Patient:   Thank you doctor. I  feel better already.

Script - Conversation with the Doctor

Doctor: Hello. I am Dr. Van. I will be the physician taking care of you today. What seems to be the problem?

Patient: Hi Dr. Van. I'm having trouble breathing, I'm dizzy and I have a fever.

Doctor:OK. How long have you been feeling this way?

Patient: For about three days now. I felt so bad last night that I came into the ER. I wish I hadn't because I have horrible insurance. My premiums are high and hardly anything is covered.

Doctor: I'm sorry to hear that. Are you part of an HMO or do you have private insurance?

Patient: I have private insurance. Anyway, is there anything you can do for me? I don't seem to be getting any better.

Doctor: Well, I'll have to check you out to be able to make a diagnosis. Let me listen to you breathe. Oh. This doesn't sound good. It is probably pneumonia. This is pretty serious. You are going to have to check in to the hospital tonight so we can observe you. Mrs. Darby, the nurse practitioner, is going to take care of you.

Patient: I thought it was serious. Honestly, it has been a while now that I haven't felt so well.

Doctor: Do you get a regular checkup each year? You may have had this for months now.

Patient: No. I never go to the doctor. With this bad insurance I try not to come in. The last time I saw a doctor was two years ago when I sprained my ankle. I wasn't even going to come in then, but it was so swollen that my husband made me go.

Doctor: Well, I understand that medical care can be expensive nowadays. However, when you are suffering from any kind of ailment, especially one this severe, it is worth the money.

Patient: Easy for you to say being a doctor who makes a lot of money.

Doctor: Okay. Well, that's just something to think about. Just wait here and the nurse practitioner will be in shortly.

Patient: Okay. Thanks Doctor.

Script - Between a Doctor and a Patient

Patient: Hello Doctor! Can you help me?
Doctor: Of course! Please come in and have a seat. How may I help you? Tell me what's wrong.
Patient: I do not feel well. I have no appetite for my food, and yet I am always suffering from indigestion.
Doctor: Do you have headaches?
Patient:  Yes, I do and I cannot sleep at night.
Doctor: What do you do (for work)?
Patient: I am a clerk in an office, and have to work long hours.
Doctor: Do you do any exercises in the evening?
Patient: I am afraid I don't exercise. I feel so tired when I get home that I simply want to sit down or go to bed.
Doctor: I see. Sounds like you are exhausted and need more rest. All your troubles are signs of nervous  exhaustion. I will give you a nerve tonic but the main thing is rest. If you do as I say, you will soon be all right.
Patient: Thank you, doctor. I will follow your advice.  Good night!
Doctor: Good night!

Script - Troubling Symptoms

Patient: Good afternoon.

Doctor: Good afternoon. Please have a seat. How may I help you today?

Patient: Thank you. I feel sick, I have a bad cough, but I don't seem to have a fever.

Doctor: I see. How long have you had these symptoms?

Patient: Oh, I've had the cough for two weeks, but feeling sick just these past few days.

Doctor: Are you having any other problems?

Patient: Well, I've got a headache. I've also had a little bit of diarrhea.

Doctor: Do you smoke?

Patient: Yes, I smoke a few cigarettes a day, but no more than a half a pack a day.

Doctor: How about allergies? Do you have any allergies?

Patient: Not that I'm aware of.

Doctor: Does your head feel stuffy?

Patient: Yes, for the past few days.

Doctor: OK. Now let's have a look. Could you please open your mouth and say 'ah?'


Key Vocabulary
symptoms
to feel ill
cough
fever
to have a cough
headache
diarrhea
phlegm
to cough
allergy
stuffy
to feel stuffy

Script - Joint Pain

Patient: Good morning Doctor Phuong.

Doctor: Yes, please come in.

Patient: Thank you. My name is Doug Smith.

Doctor: How may I help you today?

Patient: I've been having some pain in my joints, especially the knees.

Doctor: How long have you been having the pain?

Patient: I'd say it started three or four months ago. It's been getting worse recently.

Doctor: Are you having any other problems like weakness, fatigue or headaches?

Patient: Well I don't feel well in general.

Doctor: Right. How much physical activity do you get? Do you play any sports?

Patient: I like to play tennis about once a week. I take my dog on a walk every morning.

Doctor: OK. Let's have a look. Can you point to the area where you are having pain?


Key Vocabulary
joint pain
knees
weakness
fatigue
headache
physical activity
to play sports
to have pain

Script - Doctor's Diagnosis

Physician

  • Your test results have come in.
  • I'm afraid the result isn't good.
  • You have a long road to recovery.
  • We have several options to discuss.
  • The blood test came back negative.
  • The transfusion was a success.
  • It looks like you're ready to go home.
  • I'd like to keep you here over night.
  • We'll know more in a few days.
  • You're not in the clear yet.
  • We've ruled out diabetes.
  • I'm hoping to get to the bottom of this soon.

Patient

  • I don't understand what this means.
  • Am I going to need surgery?
  • Is it good news or bad news?
  • When will the tests results come in?
  • How long do I have to stay in the hospital?
  • What is the success rate?
  • Are they going to run more tests?
  • Is this a common problem for people my age?
  • I'd like to discuss other options.
  • I'm going to get a second opinion.

Sample Conversation

Doctor: Hi Jessica. How are you feeling today?
Patient: A bit better.
Doctor: That's good to hear. Are you still feeling nauseous?
Patient: No, I haven't felt sick to my stomach since you switched my medication.
Doctor: Great. Your test results came in this morning.
Patient: Is it good news or bad?
Doctor: I guess it's a bit of both. Which do you want first?
Patient: Let's get the bad news over with.
Doctor: Okay. It looks like you're going to need surgery to remove the tumour from your leg. After the operation you're going to have to stay off your feet for at least three weeks. That means no soccer.
Patient: I was afraid you were going to say that.
Doctor: Now for the good news. The biopsy shows that the tumour is not cancerous. We're going to take it out anyway just to be on the safe side.
Patient: Wow, that's a load off my mind. Thanks Doctor.
Doctor: Don't get too excited. We still need to get to the bottom of all of this weight loss.
Patient: I've probably just been so worried about this stupid lump.
Doctor: These things often are stress related, but we're still going to do a few blood tests just to rule a few things out.
Patient: Things like what? Cancer?
Doctor: Actually, I'm thinking more along the lines of a food allergy.

Script - Doctor and Patient

Patient: Good morning, Dr. Thuy!

Doctor: Good morning! How may I help you?

Patient: I have had a fever since yesterday.

Doctor: Do you have any other problem?

Patient: I also have a headache and shivering.

Doctor: Let me feel your pulse and check your fever……… At this time the fever is 102 degrees. Don’t worry, there is nothing serious. I am giving you the medicine, and you will be all right in a few days.

Patient: Thank you Doctor.

Doctor: But get your blood tested for malaria, and you will have the result tomorrow.

Patient: Okay Doctor.

Doctor: I recommend at least two days rest for you.

Patient: Would you prepare a doctor's note to give my boss?
 






https://c3.staticflickr.com/7/6178/6153468119_ff14f45b5a_b.jpg

Doctor: Oh sure…………. This is your doctor's note.

Patient: Thank you very much. How much medicine do I take?

Doctor: This medicine is for one day only. Take this dose as soon as you arrive home and the second at 3 pm and the third at night before you go to sleep.

Patient: What should I eat doctor?

Doctor: You should eat only light food. You can take milk and fresh fruit also.

Patient: How much shall I pay you Doctor?

Doctor: You can pay via cash, check or charge.

Patient: Here it is please. Thanks Doctor.

Doctor: You are welcome.

Patient: Thank you doctor. I shall see you tomorrow with my blood report.

Script - Stomachache

P:Good afternoon Doctor.

D:Good afternoon. What is your problem?

P:I have a stomachache.

D:What do you feel?

P:I have a strong pain and heartburn.

D:How long have you had this pain and acidity?

P:For 2 months now. It does not go way! My stomach hurts after every meal.. Even at night the pain persists.

D:Tell me, in the last 2 months, have you eaten any kind of heavy foods, or something different?

P:No.

D:How strong is the pain from a scale of 1 to 10. How would you describe the intensity of the pain?

P:Between 4-5

D:Is the pain continuous or does it come and go?

P:It come and goes.

D:Does the pain come after meals?

P:That's possible because it hurts every time after eating.

D:Is there a kind of food that affects you more?

P:Greasy food.

D:Greasy food affects you?

P:Yes. At home we eat a lot of greasy food.

D:Where in the abdomen does it hurt? Point please! Does the pain travel to your chest, shoulder, back or across your abdomen?

P:It hurts in the middle. Sometimes, the pain travels across my abdomen.

D:Besides the pain, you said you have heartburn?

P:Yes, after a burp, I feel a kind of sour taste.

D:Do you feel like this more during the day or in the evenings?

P:Both. I feel the acidity during the day and at night.

D:Is it worse when lying down?

P:Yes, I taste the acid in my mouth?

D:Besides greasy food, is there any other kind of food that irritates your stomach? Like spicy foods?

P:No, at home we don't eat spicy food.

D:And tell me, how often do you regularly have a bowel movement? Has that changed since you have been having these problems?

P:It is regular. It hasn't changed since the problem.

D:Have you noticed any change in the consistency of the bowel movement?

P:Yes. It is a bit softer.

D:Have you noticed any change in color?

P:Yes, it is greener.

D:Greener, not darker? Any blood in your bowel movement or black coloring of bowel movement?

P:No, not darker. I do not see any blood in my bowel movement, either.

(Begin examination of the patient)

D:Okay. What we can do first is check your abdomen to see where the pain comes from. You said the pain comes from the middle-part of your abdomen?

P:Correct.

D:And does the pain move somewhere else, or does it stay there?

P:It usually stays there.

D:But with the pain, do you always feel acidity?

P:Correct.

D:Do you have nausea or vomiting?

P:No, not at the moment.

D:Tell me, what did you eat today?

P:I ate meat with tomato sauce.

D:Do tomatoes give you any trouble?

P:No, I have always eaten tomato sauce.

D:What about orange juice, does it affect your stomach?

P:Sometimes.

D:What do you feel?

P:It gives me a strange metallic taste.

D:But it does not give you any acidity?

P:No, it doesn't.

D:And what do you do when you have stomachaches?

P:Sometimes I take Alkaseltzer. It helps a bit.

D:Yes, it helps. Do you take any Tums, Mylanta or  Maalox?

P:No.

D:Are you taking or have you been taking now or before this problem any medication on a consistent basis, like Aspirin, Advil, Motrin, etc.

P:No, usually Tylenol.

D:And if you take Aspirin, or any other kind of anti-inflammatory medicine, do you think it could affect your stomach?

P:No, I can't really tell you.

D:Okay. As I was telling you before, I am going to examine you. I want to examine your feces to check if you have any kind of parasite. Do you come from the tropics, or have you traveled anywhere recently such as the tropics, or overseas?

P:Yes.

D:Here in the United States, as well as in any other part of the world, one can find parasites. These can affect your stomach. Besides this, I want to look for any blood in your feces. You said you have not really seen any changes in your feces. It is only greener, but not darker. The digested blood, in case you have something in your stomach and you could have a hemorrhage, could produce a chemical reaction so that you can have occult blood in your feces. Many times we don't see the red color of blood or the black color of the digested blood; therefore an examination is necessary. I would also like to examine your upper gastrointestinal system through X-rays and contrast. It is a very simple thing and it does not hurt. You will drink a thick substance. The radiologist will see how you digest the substance and will see the movements of your stomach. We will have this type of examination because your pain could not come from the stomach but from the gall-bladder. After the examination, we will decide what to do first, the X-rays of an ultrasonic study of the gall-bladder. For now, do not eat greasy food. Do not eat close to your sleep time because it could cause you more acidity. Eat plain food, nothing spicy. As soon as I get the results from the medical test, I will talk to you. Do you have any questions?

P:With so many medical tests, I was wondering if I have an ulcer.

D:We need to think of that too. That is why I want that test. I need to explain to you that an X-ray of the upper intestine sometimes cannot detect an ulcer or other irritations. If the pain persists after some antibiotics you will need an endoscopy. An endoscopy is a medical examination in which the doctor inserts a tube through your mouth or nose.Then, the specialist will observe your stomach, from the small intestine to the large one, and your gullet. Any other question?

P:No doctor, thank you.

D:Good. We will see each other next week. Good bye.



Doctor : Hello! What can I do for you? Patient : Good Morning Doctor. I am not well. Doctor : Please have a seat. Doctor : Open your mouth. Doctor : How long have you not been feeling well? Patient : Since yesterday. Doctor : No problem.  Did you have a bowel movement yesterday? Patient : No Doctor.Patient : Doctor, I feel dizzy. Patient : I don’t feel like eating at all. Doctor : Do you have any other problems?Patient : I feel like vomiting. Doctor : Do you drink a lot of water? Patient : No Doctor, I don't drink too much. Doctor : Did you take any medication? Patient : Yes Doctor, I took Anacin.

Script - Simple Conversation with a Doctor

Doctor : Hello! What can I do for you?
Patient : Good Morning Doctor. I am not well.
Doctor : Please have a seat.
Doctor : Open your mouth.
Doctor : How long have you not been feeling well?
Patient : Since yesterday.
Doctor : No problem.  Did you have a bowel movement yesterday?
Patient : No Doctor.
Patient : Doctor, I feel dizzy.
Patient : I don’t feel like eating at all.
Doctor : Do you have any other problems?
Patient : I feel like vomiting.
Doctor : Do you drink a lot of water?
Patient : No Doctor, I don't drink too much.
Doctor : Did you take any medication?
Patient : Yes Doctor, I took Anacin.
Doctor : Who told you to take it?
Patient : Nobody Doctor. I took it myself.
Doctor : Why did you take it?
Patient : Because I had a headache.
Doctor : Nothing to be worried about.
Doctor : Do you need immediate relief?
Patient : No need sir. The medication you give me is enough.