medical English 專欄(八)

SKIN

(I)               Case

Hubert was a 65-year-old diabetic who developed a skin infection on the back of his short, bull neck. The infection rapidly progressed from a “boil” to a large, deep, spreading abscess. His diabetes went out of control and he developed shaking chills and a fever of 104 degrees. Under general anesthesia, a doctor removed a large area of dead tissue. His incision measured three by six inches, by three inches deep. However, “all’s well that ends well.” He was discharged after three days in the hospital, and managed his own care of the incision, with the help of his wife, obtaining complete healing six weeks later. 

(II)           Q&A

  Q: What seems to be the problem?

   A: 1. She has red spots and blisters.

      2. The skin of my arms and feet itch all the time.

      3. I have rash that develops over chest after wearing clothing.

      4. The mole on my face became larger gradually and it changed color too.

      5. He had raised, red, itchy welts over both arms after taking a drug.

      6. I have cracked, itchy, peeling skin between the toes of my feet.

   Q: How long has she had this problem?

   A: 1. She had a few blisters two days ago. I thought it wasn’t serious.

      2. In the beginning, we found few red spots on her face 3 days ago, but now they are all over her body. 

      3. We found a crusty rash between her nose and upper lip 2 days ago.

      4. It progressed rapidly since two days ago.

(III) What he said

   Eczema often causes a very intense itch reaction, so the person is always rubbing and scratching. You always have to be aware of it, plan your day around it. You start thinking of your skin as a separate entity. You ask yourself, “Today, can I garden? No, my hands won’t let me do it. Your skin is the largest organ of the body, and you become very aware of it.

   In dry climates like we have here in Minnesota, especially in the winter, we use fair Emollients, even Vaseline. At night, I sleep with my hands in a light pair of cotton gloves, and I put vinyl exam gloves over that.

(IV)        Skin Infection

A skin infection usually starts when bacteria gain entrance into or through the skin’s surface by way of a hair follicle, sweat gland, cut or scrape, or surgical incision. Your immune defence begins with an inflammatory response, which brings increased blood flow to the involved area. Your white blood cells arrive to engulf the bacteria, while your circulating antibodies kill them directly. The classic sign of infection – redness, warmth, swelling, and tenderness – develop during the time the invading bacteria are being battled.

(V)           Hives

Hives are raised, red, itchy, often fluid-filled patches of skin called wheals or welts that may appear and disappear at random. They range in size from less than 0.6 cm to 7.5 cm across or more, and they may last a few minutes or a few days.

A single hive commonly develops after an insect sting. Multiple hives often develop in response to a medication, food, or infection. Other possible causes of hives include plant allergies, inhaled allergens, stress, cosmetics, and exposure to heat, cold, sunlight, or natural rubber latex. Often a cause cannot be found.

(VI)        When to Call Your Doctor

Call your doctor if you notice any unusual skin changes or growths, especially if they bleed and continue to change.

l   Asymmetrical shape: One half does not match the other half.

l   Border irregularity: The edges are ragged, notched, or blurred.

l   Colour not uniform: Watch for shades of red and black, or a red, white, and blue mottled appearance.

l   Diameter: A mole is larger than a pencil eraser. (Harmless moles are usually smaller than this.)

And also call if you notice:

1.      Scaliness, oozing, bleeding, or spreading of pigment into surrounding skin.

2.      Appearance of a bump or nodule on the mole.

(VII)    Vocabularies

                  Skin swelling / Puffiness

                      Severe itching

                      Skin irritation

                      Fungus infection

                      Blister

                      Skin rash

                      Eczema

                      Urticaria

                      Bruise

                      Mole

                      Warts / Corn

                      Puncture wound

(VIII)  Dialogues

P: The toes and soles of my foot itch all the time. Cracks on my heel here hurt, too. Have I got so called athlete’s foot?

N: Yes. We call it Tinea Pedis. Rub this ointment of the infected area each night after washing and drying your feet. Keep it on overnight. Wash your feet again each morning, dry them and then spread this powder on your feet and socks if you have to wear shoes.

P: Is it easy to cure this fungal infection?

N: Not easy. You have to keep applying the ointment for many weeks. The ointment is effective. It penetrates your skin and removes irritation.

P: There are pimples on my leg here. They scale, crust and ooze fluid, accompanied by intense itching and burning.

D: They are eczema …… Don’t scratch. The more you do, the more they spread. The eczema is usually caused by a variety of irritants acting outside on the skin or circulating in the blood. Are you sensitive to any allergens?

P: I don’t know. Can’t you detect the cause of my allergy by some tests?

D: Medical tests are performed by the lab. Take this form to the technicians. They will find the cause of your allergy.

P: Shall I go to the lab now?

D: Wait a moment. I’m giving you a tube of anti-inflammatory ointment. It alleviates inflammation, relieves your itch and restricts the secretion of fluids. Now you can go to the lab. Come back next week to see the result of the laboratory report.

medical English 專欄 (七)

THE REPRODUCTIVE SYSTEM

(I)               Case

Michael, the 46-year-old Wall Street celebrity, decided to take a PSA test when a close friend died of prostate cancer. Surprisingly, his level was abnormal and his disease was found to already be present in the local lymph nodes. It was too widespread to be cured by surgery. He chose to be treated with radiation and hormone therapy, then devoted much of his time and money to research and education about this disease. He began eating a vegetarian, low-fat, high-fiber, soy-based, whole-foods diet. As of seven years after his metastatic diagnosis, he remained in complete remission, with a normal PSA, continuing with an active life and having his progress closely monitored.

(II)           Q & A

Q: What seems to be the troubles that bother you?

A: 1. I have difficulty in starting and stopping urination.

   2. I have interrupted flow of urine.

   3. I am not able to completely empty the bladder.

   4. I have a heavy, dragging sensation in my groin, and low back pain too.

   5. I feel tenderness in both testicles.

   6. I have discharge from penis.

   7. I have difficulty in having an erection.

Q: What other symptoms do you have?

A: 1. I have stiffness in the lower back and upper thighs.

   2. I have trouble sleeping through the night.

   3. I have cramp in my lower abdomen. It comes and goes in waves.

   4. I have night sweats, sometimes followed by a chill.

(III)        BPH (Benign Prostatic Hyperplasia)

As a man ages, the prostate may enlarge. This seems to be a natural process and is not really a disease. However, as the gland gets bigger, it may squeeze or partially block the urethra and cause urinary problems, such as:

l   Difficulty getting the urine stream and completely stopped (dribbling).

l   Frequent urge to urinate, or being awakened by the urge to urinate.

l   Decreased force of the urine stream.

l   Having the sense that the bladder is not completely empty after urinating.

An enlarged prostate gland is not a serious problem unless urination becomes difficult or backed-up urine causes bladder infections or kidney damage. Some dribbling after urination is very common and not necessarily a sign of prostate problems.

(IV)        Prostate Cancer

l  Prostate cancer is usually very slow-growing, producing no symptoms in its early stages. In fact, autopsies reveal that up to one-half of all men have this cancer, although most did not have symptoms and were not even diagnosed before their death from other conditions. Although early cancer is readily curable, one third of all patients have cancer that has already spread outside of the prostate at the time of their diagnosis.

l  The older you are, the greater your risk for prostate cancer. Eighty percent of these cancers are diagnosed in men older than 65, and 80 percent of all 80-year-old people are found to have some cancerous cells in their prostates.

       

l  The blood tests for prostate specific antigen (PSA) and prostate alkaline phosphatase (PAP) can be used to detect very early cancer spread. They can also be used to judge the success of treatment. However, their use for screening is controversial, as BPH can also elevate the antigens that these tests detect, and there are many false positive.

(V)           Trim The Risk

You may be able to prevent prostate cancer in the first place. One way to do this is at the dinner table.

l   Trim the fat. Researchers have found that men who skimp on high-fat foods such as eggs, meat and cheese may substantially reduce their risks for prostate cancer. In one study, researchers in Utah investigated the diets of 358 men with cancer of the prostate. “Eating high-fat foods,” the researchers concluded, “was the strongest risk factor for developing prostate cancer”.

l   Add fiber to your diet. Some researchers believe that foods high in dietary fiber—for example, beans, dried fruit and whole-wheat breads – can further lower the prostate cancer risk.

l   Stay active. According to a Harvard study, men who stay active all their lives may have only half the risk of prostate cancer compared with those who are inactive.

l   Add foods that contain tomato or tomato sauce to your diet.

l   Increase your intake of soy products.

(VI)        Vocabularies

          Inguinal Hernia                                  Vaginitis

            Hydrocele                                           Vaginal Yeast Infection

            Phimosis                                              Menopause

            Testicular Cancer                               Prolaps of Uterus

            Impotence / Erectile Dysfunction      Osteoporosis

            Bloody Semen                                     Hot Flash

            Reduce Libido

            Nocturia

            Urinary Retention

            Endometriosis

            Cervical Cancer

            Ovarian Cancer

            Menorrhagia / Heavy Period

            Amenorrhagia

(VII) Dialogues

P: Recently, I have difficulty starting urination and holding it back.

D: When did you notice it?

P: It was about three weeks ago. I found I needed to urinate frequently, especially at night.

D: I need to do a rectal examination on you to check your prostate.

P: A rectal examination? What is that?

D: I am going to insert a gloved finger into your rectum. You may feel a little uncomfortable. …. It seems you have an enlarged prostate gland.

P: Is it serious?

D: I don’t know yet. You need to have a urine test and a blood teat.

P: Do I need an immediate medical attention?

D: It is a common problem for a man. If the test results show the symptoms are mild and there are no other complications, I may suggest watchful waiting.

P: Watchful waiting?

D: Yes, we will wait for a while and periodically evaluate your condition.

Medical English 專欄 (六)

THE URINARY SYSTEM

(I)                           Case

Celeste loved cheese, ice cream, and cappuccino with lots of whipped cream. While driving home after an long working day during which she was too busy even to drink water, she developed sudden severe pain in the left mid-back. Tests revealed a stone in the upper part of her ureter, but with only partially blocked urine flow. She elected to try conservative treatment and spent the following days drinking copious amounts of barley water and eating watermelon. The stone passed few days later. She then close to avoid caffeine and dairy products, and always carry a bottle of spring water in her purse.

(II)                       Q & A

Q: Is there anything that you worry about?

A: 1. I have slight chronic back pain in my right kidney area.

   2. I have poor urinary flow.

   3. I have an urge to urinate frequently.

   4. I have a burning sensation when urination.

   5. I have pain at the start of urination.

   6. I have continuous pain in the lower right side pelvic area, sometimes radiating to the back.

   7. I have cloudy urine.

Q: Does any of your family members have hypertension or other chronic disease

A: 1. My brother has hypertension. His blood pressure reached 210/140.

   2. My father died of kidney cancer when I was 20 years old.

   3. My father and grandfather were both suffered from diabetes and hypertension..

   4. My father had hypertension, and he had a heart attack last year.

 (III)  Kidney stone

About 80 percent of all kidney stones simply pass on their own, usually with your urine within 48 hours. Typically, “renal colic” is a severe pain that has a sudden onset, as the stone blocks the kidney outlet or moves into your very sensitive ureter.

The pain begins in your flank, and radiates down around the lower abdomen into your groin area. You can’t get comfortable. The discomfort may first come in waves, intensifying over a fifteen-to thirty- minute period, to then become steady and excruciating. Finally, the pain may suddenly vanish, as the stone stops moving or passes into your bladder. An attack may be accompanied by nausea and vomiting. You may notice blood in your urine, burning and frequency with urination, or urinary retention. If you also have an accompanying infection, you may develop fever and chill.

(IV)         UTI: Urinary Tract Infection

Burning, frequent urination, painful spasms, and occasional blood urine – these are the all-too-familiar symptoms of urinary tract infections.

UTIs are caused by bacteria from vagina or intestinal tract that migrate up the urethra (urine tube) into the urinary tract, where they multiply within 24 to 48 hours and cause infection.

Urinary tract infections include bladder infections (cystitis) and kidney infections (pyelonephritis).

(V)           What Doctors Say?

1.      Once you’ve had one stone, you are at a somewhat higher risk of getting another. Once you’ve had a second stone, your risk is markedly increased.

2.      By far the single most important preventive measure is to increase water consumption, enough to pass 2 quarts of urine a day.

3.      Of all the stones we see, 92 percent are made of calcium or calcium products. And almost all of the calcium in your diet comes from dairy products. About 60 percent of all stones are known as calcium oxalate stone.

        4. People who are inactive tend to accumulate a lot of calcium in the bloodstream. Activity helps to

              pull calcium back into the bones, where it belongs.

        5. There is a direct correlation between the incidence of kidney stone disease and the amount of protein eaten.

(VI)        Change Your Diet

Most kidney stones are preventable. A diet high in meat, eggs and diary products is the root cause of this prevalent problem. Animal protein in the diet causes the body to excrete more calcium in the urine, to buffer the presence of the excess amino acids in your bloodstream.

Meat also contains purine, which is changed to uric acid in the urine, favoring stone formation. Vegetarians have a lower risk for kidney stones. Changing to a low-fat, vegetarian diet, free of dairy, may be all you need to do to prevent new stones from forming. Adequate fiber in your diet is important too. It acts to bind calcium in your digestive tract, and thus prevent increased amounts from reaching your bloodstream.

(VII)    Vocabularies

                   Cystitis

                   Nephritis

                   Renal Failure / Renal shutdown

                   Kidney Cancer

                   Hematuria / Red Urine

                   Bladder Stone

                   Proteinuria

                   Pyuria

                   Uremia

                   Cloudy Urine / Milky Urine

                   Urinary Incontinence  

                   Oliguria

(VIII)   Dialogues

P: Doctor, what is the cause of his kidney disease?

D: His kidney has been infected by bacteria. We will use antibiotic therapy to control the infection.

P: Would the disease lead to uremia if the treatment is not successful?

D: His disease is not severe. I’m confident we can cure it very soon. Two years ago, I successfully removed his kidney stones.

P: If his disease leads to uremia, what should we do, doctor? Will you use radiotherapy or nephrectomy to save his life?

D: The probability of uremia is very low. If that unfortunately happens, I’ll suggest kidney dialysis or a kidney transplant. Our hospital has sophisticated machines to filtrate his blood. We have competent surgeons to perform kidney transplants too, if his brother would donate a kidney for him.

P: Why do so many people have kidney problems?

N: It’s hard to say. Excessive intake of salt, alcoholism, arteriosclerosis, lead poisoning…… many things can all cause kidney problems.

Medical English 專欄(五)

THE RESPIRATORY SYSTEM

(I)               Case

  Frank, a 65-year-old stockbroker with a 90 pack/year history of smoking, had a screening Chest X-ray that showed a small (three-eight-inch) nodule in the lower lobe of his left lung. The spot was not present on his Chest X-ray two years before. Exploratory surgery proved that it was a cancer, without any evidence of having spread. The lobe containing the tumour was removed. Frank recovered easily and wisely used his hospitalization as a time to stop smoking.

(II)           Q & A

Q: Do you have any problem?

A: 1. I cough frequently and cannot sleep well at night.

   2. I have had persistent cough for 3 months and sometimes felt breathless.

   3. I cough up sputum and feel muscle ache.

   4. I have runny nose, sore throat, and headache.

   5. I was suffered from night cough and shallow breathing in this winter.

   6. The dry cough at night persistently bothered me for a year.

   7. I feel headache and tired, because my nose is stuffy. I can’t breathe normally.

Q: Do you have fever, chest pain or other symptoms?

A: 1. I have fever, sometimes up to 38.5 degree.

   2. I feel upset in stomach when I have a bad cough.

   3. I have a sense of constriction in the chest.

   4. My mucus becomes yellow and sometimes contains blood.

(III)        Early Detection of Lung Cancer

Your first symptom of lung cancer may be an irritating cough or a streak of blood in the sputum. The tumour may block a small bronchial tube, causing pneumonia in the lung tissue beyond the blockage. Chest pain and shortness of breath indicate a more advanced tumour that has invaded neighbouring sensitive tissues or has affected a large amount of the lung. Occasionally, the first symptom is caused by the cancer’s spread to the brain, bone, or liver.

(IV)        After Operation

Postoperatively, you awaken in the recovery room, and a short time later are moved to the ICU (Intensive Care Unit). The breathing tube, left in place until you need no further breathing assistance, can usually be removed after the effects of anaesthesia have worn off. If you are debilitated or have poor function in your remaining lung tissue, the tube may be necessary for several days, or even longer. Lines and tubes monitor your EKG, lung and cardiac function, blood pressure, and urinary output. Once you are off the ventilator and are in stable condition, you can be moved out of the ICU.

(V)           When to Call a Health Professional

Any of the following symptoms may mean that your lung infection is getting worse or that you are developing a bacterial lung infection.

l   A cough that

-- Occurs with wheezing or difficulty breathing that is new or different.

-- Brings up bloody sputum.

-- Frequently produces yellow, green, or rust-coloured sputum from the lung (not post-nasal drainage) and occurs along with a fever of 38.3 degree or higher.

--Lingers more than 7 to 10 days after other symptoms have cleared, especially if it is productive (bringing up sputum).

l   A fever of 40 degree or higher that does not go down after 2 hours of home treatment.

l   A fever that persists for 3 days despite home treatment.

l   Laboured, shallow, or rapid breathing with shortness of breathe.

l   Significant chest-wall pain when you cough or breathe.

                                

(VI) Lifestyle Change

1.      Don’t smoke

The average cigarette smoker is 10 to 15 times more likely to develop lung cancer than his non-smoking counterpart. And his risk increases as the number of cigarettes per day increases. A man who smokes two or more packs per day, is 20 to 25 times more likely to develop lung cancer than a non-smoker.

2.      A study of 1,500 Chinese men and women indicates that people who inhale oil vapours while frying food are more likely to get lung cancer than those who don’t.

(VI)        Vocabularies

                     Flu / Influenza

                          Asthma

                          Pneumonia

                          Lung Abscess

                          Chronic Bronchitis / Smoker’s Cough

                          Sneezing

                          Wheezing

                          Runny Nose / Stuffy Nose

                          Cyanosed Lips

                          Itchy Eyes

                          Post Nasal Drip

     Questions to ask

1.      What type of cancer do I have and how far has it progressed?

2.      How does this type of cancer usually respond to treatment?

3.      What are my treatment choices?

4.      When will treatment start and end, and how often will I have it?

5.      What are the possible side effects of this type of cancer or its treatment?

6.      How can I manage side effects?

7.      Should I make changes to my day-to-day life?

(VII)    Dialogues

P: I am afraid I have got a mild temperature, doctor. My nose is stuffed up.

D: Open your mouth and let me see your throat.

P: I know I have a sore throat.

D: Yes, and you have a temperature of 38 degrees as well. You have all the symptoms of the flu.

P: What am I supposed to do?

D: There is very little you can do for the flu. Drink more water and take a rest certainly will help.

P: Doctor, my eyes are tearing and I keep sneezing. It is interfering with my work now.

D: You are suffering from the allergic reactions of hay fever. How long have you had them?

P: I had my first hay fever symptoms four years ago. It has been getting worse each year.

D: It would e a good idea to stay indoors when the pollen count is high. It is caused by the pollen particles in the air from trees and weeds.