MT News Desk

Dr. Vidya Shaju

Dr. Rema Valsala

AN OUNCE OF THE

MIRACLE DRUG

An ounce of ‘prevention’ could cure about 70% of diseases.

In the last newsletter, we began a column on disease prevention.   We looked at heart disease from a preventive perspective.  This time, let us look into colon cancer, and what we could do to prevent this  disease, which is the third most common form of cancer and the second leading cause of cancer-related death in the Western world.

Tests to Prevent Colon Cancer

Test

Recommendation

Testing stool for blood

If you have a parent, brother, or sister with colorectal cancer or inflammatory bowel disease, every one to three years after age 40. Otherwise, every one to three years beginning at age 50.

Sigmoidoscopy (this test usually isn’t necessary if colonoscopy is performed)

If you have a parent, brother, or sister with colorectal cancer or inflammatory bowel disease, every one to three years after age 40. Otherwise, every one to three years after age 50.

Colonoscopy

At least once after age 40 if you have any of the following:

• more than one first-degree relative with colorectal cancer
• close relatives with familial polyposis or intestinal polyps
• ulcerative colitis for more than 10 years
• previous intestinal polyps.

Otherwise, every 10 years after age 50.

The Medical Transcriptionist – a Medical Language Specialist

Doctors rely on transcriptionists for the accuracy of medical records and the speed of recording. An example of how a transcriptionist may need to record something not verbatim is when he/ she would need to expand some contracted or abbreviated forms.

Here are some terms to be expanded when dictated in the contracted form.

Watch out for more such terms in the next issue!!

FAQ

What is pill-rolling movement?

Pill-rolling movement is a resting tremor of the thumb and fingers seen in Parkinson disease.  Tremor is an involuntary rhythmic shaking in an extremity (like an arm or leg), or in the face.

Tremor or shaking caused by Parkinson disease occurs when the person is awake and sitting or standing still (resting tremor) and subsides when the person moves the affected body part.  The tremor becomes worse when the patient is anxious or emotional.  Typically, the tremor takes the form of a rhythmic back-and-forth motion of the thumb and forefinger at three beats per second.  This is sometimes called "pill rolling."  Tremor is rarely disabling and it usually disappears during sleep or improves with intentional movement.

Although tremor is one of the most common signs of Parkinson disease, about 50% of people who have a tremor do not have Parkinson disease.  In contrast to tremor caused by Parkinson disease, tremor caused by other conditions typically improves with rest, does not improve during movement, or gets worse when the person attempts to perform a task.

What is the calf squeeze test?

The calf squeeze test (also called the Thompson or the Simmond test) can identify an Achilles tendon rupture.  While an individual is kneeling on a chair with the legs hanging over the edge, or lying face down with the lower legs bent up 90 degrees, a health professional will squeeze the calves.

• If the Achilles tendon is still attached, the foot will flex downward.
• If the tendon is ruptured, the foot will not move.
• If there is a partial tear, the calf squeeze test may be normal.

QUESTIONNAIRE

Q.  The term used for vault like corneal herniation with severe regular myopic astigmatism is ____________.

a. keratorus

b. keratorrhexis

c. keratosis

Q.  A term that denotes blood relationship is __________.

a.  conceptual

b.  concordance

c.  consanguinity

Q. Fill in the blanks with the suitable word given in brackets:

1.  The patient was warned of the _________ complication. (imminent, eminent)

2.  He was careful to leave no _______ of his whereabouts. (trial, trail)

3.   During the examination she displayed emotional ________ and tearfulness. (liability, lability)

4.   We will _________ to the request of the patient to refer her to cardiology for an annual followup. (ascent, assent)

5.   The current x-ray shows evidence of pleural __________.  (effusion, infusion)

Q.  Find the meaning of these homonyms:

aphakia and aphasia

ketosis and keratosis

narcosis and necrosis

Watch out for answers in the next issue!!!!

Procedure of the Month

Colonoscopy

Colonoscopy is visual examination of the inner surface of the entire large intestine, or colon by means of a long, flexible fiberoptic tube, about the width of the index finger, known as colonoscope. 

Within the end of this tube is a miniaturized color-TV camera with a wide-angle lens.  After passing this "scope" through the rectum and into the colon, the lining of the entire length of the colon can be visualized on a television monitor.  In this manner, it is possible to evaluate colitis (intestinal inflammation), ulceration, bleeding, diverticulitis, colon polyps, tumors, etc.

Colonoscopy is used as a screening test to detect colon cancer.  Colon cancer is common, silent and often deadly; it is the second leading cancer killer in the United States, and the third most common cancer overall.  If colorectal cancer is found early enough, the patient has more than a 90 percent chance of survival.  Almost all colon cancers begin as a small non-cancerous polyp on the inner wall of the colon.  A polyp may grow for many years before cancer cells develop.  Screening colonoscopy helps to detect and remove any polyps before cancer cells form.  In this manner, a potential colon cancer can actually be prevented.  The American Cancer Society recommends periodic screening colonoscopy exams for all adults starting at age 50. Those with a family history of colon cancer or polyps should start at an earlier age and be checked more often.     

A colonoscopy exam requires a thorough cleansing of the large intestine.  The colon must be completely free of all solid waste.  This is achieved  by a special dietary and laxative preparation on the day prior to the test.  This test can be done on an outpatient or inpatient basis.  An intravenous injection of a painkiller and tranquilizer will make the individual drowsy and relaxed, thus minimizing any discomfort during the examination.  The rectal opening is then lubricated for easy passage of the colonoscope.  The whole process takes approximately one-half hour. To improve visualization, air is gently infused into the colon.  This may cause a sensation of abdominal fullness, but should not be painful.  With the advent of video-colonoscopy, it is now also possible to record the examination on a videocassette for later review when necessary.  Biopsy specimens, washings, cultures, and other materials can be obtained by colonoscope.  A brushing involves the passage of a tiny nylon brush through the center of the colonoscope.  The brush rubs against the lining of the colon and retrieves bits of tissue for later analysis.  To take a biopsy, the doctor passes a metal forceps through the scope and snips off a tiny sample of colon tissue for laboratory analysis.  A polyp is removed by placing a wire loop, or "snare," around the polyp's base and slowly tightening the loop.  As the polyp is severed, a mild electric current cauterizes the tissue to prevent bleeding. All these procedures are totally painless for the patient.   

Periodic colonoscopy is a valuable tool in monitoring patients with previous polyps, colon cancer, or a family history of colon cancer.  Essentially, colonoscopy is a safe and worthwhile procedure that is extremely well tolerated.  

The A-Z Eponym Quiz

An eponym is a name derived from a person. For example,  ‘Kawasaki disease’ is derived from the Japanese pediatrician Tomisaku Kawasaki.  Note that modern medical dictionaries as well as documentation standards advocate the omission of the ‘s viz., it would be ‘Kawasaki disease’ rather than ‘Kawasaki’s disease.’

The clues to the following quiz: Answer to Question A begins with A . Answer to Question B begins with B and so forth until Z.

1. a progressive degenerative disease of the brain that causes impairment of memory and dementia manifested by confusion, visual-spatial disorientation, inability to calculate, and deterioration of judgment; delusions and hallucinations may occur.
2. Facial paralysis
3. Inflammatory bowel disease
4. Inflammation of the tendons of the first dorsal compartment of the wrist.
5. A group of connective tissue disorders characterized by hyperelasticity and fragility of the skin, hypermobility of the joints, and fragility of the cutaneous blood vessels of the skin
6. Rheumatoid arthritis, neutropenia & enlargement of the spleen
7. Ascending muscle weakness & paralysis; usually self-limiting (idiopathic polyneuritis)
8. A disease marked by chronic enlargement of the lymph nodes, often local at the onset and later generalized, together with enlargement of the spleen and often of the liver.
9. A condition in which the tissue of the spleen is divided into nearly equal masses or totally absent.
10. Epilepsy that initially involves one part of the body and then progressively spreads to other parts of the body on the same side, often originating in the primary motor cortex
11. Cancerous condition (adenocarcinoma) typically originating from the stomach spreading to the ovaries.
12. A childhood condition characterized by a temporary loss of blood supply to the ball portion of the hip joint , i.e., the femoral head (avascular necrosis of the hip)
13. Connective tissue defect with long limbs, joint laxity etc.
14. Lysosomal Storage Disease sphingomyelinase deficiency
15. A delusional belief in the infidelity of one’s spouse
16. Neurologic syndrome usually resulting from deficiency of the neurotransmitter dopamine
17. A T-shaped depression in the occipital bone occurring in many cases of rickets, especially in infants lying constantly in bed with pressure on the occiput.
18. Recurrent spasm in the blood vessels of the extremities caused by cold or emotion.
19. Syndrome showing the triad of dry eyes, dry mouth & arthritis
20. A tic disorder appearing in childhood, characterized by multiple motor tics and vocal tics present for more than 1 year.
21. The ill effects of extensive diagnostic investigations conducted because of a false-positive result in the course of routine laboratory screening.
22. ‘Trench mouth’, a severe form of gingivitis that causes painful, infected, bleeding gums and ulcerations.
23. An electrocardiographic pattern sometimes associated with paroxysms of rapid heartbeats.
24. Another name for Turner syndrome
25. A rare disorder characterized by chronic sinus and lung infections as well as reduced fertility due to azoospermia.
26. A disorder with tumors in the pancreas and duodenum as well as ulcers in the stomach and duodenum.

Watch out for answers at the end of the newsletter.

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Americanisms

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Let’s Grab a Burger

A  patient’s history of presenting illness could be traced back to eating some kind of food. The medical record of that patient could contain excerpts from the menu that the patient had a while back.

Let us look at one of the most common of American meals – the hamburger.  A hamburger (or simply burger) is an American sandwich that consists of a cooked patty of ground meat and is generally served with various garnish or condiments like ketchup, mustard, mayonnaise, lettuce, tomato, onion, relish, pickles and cheese toppings, placed inside a sliced bun, often baked specially for this purpose, or pieces of bread or toast. The meat patty is beef, unless otherwise noted.

In North America burgers can be divided into two main types: fast food hamburgers and individually-prepared ones made in homes and sit down restaurants.

The cheese used in burgers is often processed cheese slices but often cheddar cheese, Swiss cheese, or blue cheese, either melted on the meat patty or crumbled on top, could also be used.

Condiments are usually added to the hamburger but they may be offered separately on the side and include , mustard, tomato ketchup, mayonnaise, salad dressings and barbecue sauce. 

Other popular ingredients include bacon, avocado or guacamole, sliced sautéed mushrooms, cheese sauce and/or chili .

Somewhat less common additions/ingredients include fried egg, scrambled egg, feta cheese,blue cheese, salsa and other kinds of chile peppers, anchovies, slices of ham, pastrami or teriyaki-seasoned beef, tartar sauce, french fries or potato chips.

The American burger which is an assortment of options, flavors, innovations and ingredients is indeed a gastronomic representation of everyday America!

Answers to the A-Z Quiz

A Alzheimer disease

B Bell Palsy

C Crohn disease

D De Quervain tenosynovitis

E Ehlers-Danlos Syndrome

F Felty's Syndrome

G Guillain-Barré syndrome

H Hodgkin disease

I Ivemark syndrome

J Jacksonian Seizures

K Krukenberg Tumor

L Lou Gehrig disease

M Marfan disease

N Niemann-Pick disease

O Othello syndrome

P Parkinson disease

Q Quant sign

R Raynaud disease

S Sjogren syndrome

T Tourette syndrome

U Ulysses syndrome

V Vincent disease

W Wolff-Parkinson-White syndrome

X XO syndrome

Y Young syndrome

Z Zollinger Ellison Syndrome

A two-monthly newsletter

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Health Tip of the Month

Researches say that eating beans can reduce your risk of heart disease and stroke and help prevent cancer.

Beans are a rich source of antioxidants.

One-third cup of cooked beans contains about 80 calories, with little fat, no cholesterol, and plenty of complex carbohydrates. Beans are also a good source of B vitamins, potassium and fiber.

Beans make a great side dish. Eating grain or dairy products along with beans could supplement all the proteins in meat.

ESL KORNER

Transcriptionists and doctors alike would like to know how an ESL (English as a Second Language) speaker would sound when compared to an American speaker.

Let us examine different situations.

Asian Style:  Did he lose consciousness for a long time?

American Style:  Was he unconscious for a long time?

Asian Style:  There is a meeting today afternoon.

American Style: There is a meeting this afternoon.?

Asian Style:  I forgot his number at my apartment.

American Style:  I left his number at my apartment.

Asian Style:  Wait for your turn, please.

American Style:  Wait your turn, please.

Asian Style:  Which of these two plans would you prefer more?

American Style:  Which of these two plans would you prefer ?.

RX Fives

5 DRUGS APPROVED BY THE FDA WITHIN THE PAST 5 MONTHS

Luvox (fluvoxamine maleate); For the treatment of depression; approved April 2008

Emend (fosaprepitant dimeglumine); For the treatment of HIV; approved January 2008

Simcor (niacin; simvastatin); cholesterol-lowering medication; approved February 2008

Pristiq (desvenlafaxine succinate); For the treatment of depression; approved February 2008

Intelence (etravirine); For the treatment of HIV; approved January 2008

Colonoscopy

Illustration 1    

Illustration 2

Transcription   Bloopers

Now, Ms.Transcriptionist was trying to be religiously verbatim with the doctor or was she ….? !!!

             The patient wishes to establish with a neurologist  with the diagnosis of Parkinson's disease.

The patient has been depressed ever since she began seeing me in 1983.

           He describes the ear pain as being in the ear.

Humor; one tablet, once a month

"The doctor said he would have me on my feet in two weeks."

"And did he?"

"Yes, I had to sell the car to pay the bill."

Answers to the Questionnaire in the previous issue

The term used for normal sensory perception of the extremities is acrognosis.

The medical term for relapse or recurrence of a disease is palindromia.

An appointment was made in conformation with the patient's schedule.

The patient required IV infusion of diazepam to control his seizures.

She was asked to extend his hand for the test.

The patient developed erythema and induration of his skin.

The fixation screws were found to be loose.

Allude:  Make a more or less disguised reference to

He alluded to the problem but did not mention it.

Allure:  The power to entice or attract through personal charm

The splendor of the setting sun is an alluring sight.

Arthrosis:  Synonym of joint

Post reconstruction film failed to show a pseudoarthrosis (false joint).

Orthosis:  An external orthopaedic appliance, as a brace or splint, that prevents or assists movement of the spine or the limbs.

She was fitted with an orthosis for her plantar fasciitis and related heel pain.

Coastal:  relating to a coast.  The coast is defined as the part of the land adjoining or near the ocean.

An accelerated trend in sea level rise is threatening natural coastal habitat.

Costal:  relating to a rib

The true ribs are the seven upper ribs on either side, connected to the sternum by their costal cartilages.

A newsletter with a difference