Cure Sometimes, Relieve Often, Comfort Always

Cure sometimes, relieve often, comfort always

Art of medicine

Reality in the practice of medicine, physicians can only cure diseases sometimes they offer relieve oftentimes; but they should provide comfort always.

I believe in this. I adhere to this aphorism.

ROJoson

doctor_cure_sometimesquote-cure-sometimes-treat-often-comfort-always-hippocrates-68-43-70quote-to-cure-sometimes-to-relieve-often-to-comfort-always-edward-livingston-127-80-67


ROJ@18jun20

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Breast Cancer Survivor Myrna Sismaet – 11 Years in Remission

Eleven years ago (2007), I operated on Myrna Sismaet in Ospital ng Maynila Medical Center.  She was 59 years old at that time.  I did a modified radical mastectomy.   She took only tamoxifen for 5 years without other treatment.  She went abroad in 2011 where she continued her checkup.  She is now back in the Philippines for good. Lately, she came to me for check-up.  At age 70, she is now 11 years in remission.  We both thank God for this long remission.

Published with permission.  She wants to inspire other people with this publication.

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ROJ@18jun19

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Physical Examination, Physical Diagnosis and Clinical Diagnosis of Thyroid Disorder – Part 3 of Physical Examination

Physical Examination and Physical Diagnosis and Clinical Diagnosis of Thyroid Disorder

Diagnosis is an end-of-assessment statement on condition of the human body and its part – whether normal or abnormal; if abnormal, what kind of abnormality is suspected.

Diagnoses are commonly labelled as clinical diagnosis, physical diagnosis, radiologic diagnosis, operative diagnosis, laboratory diagnosis, histopathologic diagnosis, etc. depending on how the diagnoses are derived at, more specifically, from what type of examinations and from what type of diagnostic procedures.

Clinical diagnosis means the diagnosis is derived from data from the history or interview (or what are usually known as symptoms) and data from physical examination (or what are usually known as signs).

Physical diagnosis means the diagnosis is derived from data from the physical examination.

Radiologic diagnosis means the diagnosis is derived from a radiologic examination.

Operative diagnosis means the diagnosis is derived from the intraoperative findings.

Laboratory diagnosis means the diagnosis is derived from a laboratory examination.

Histopathologic diagnosis means the diagnosis is derived from a microscopic examination of tissue specimen.

As mentioned, physical examination can lead to a physical diagnosis.  Physical examination of the thyroid gland can lead to a diagnosis whether there is a thyroid disorder or not and if there is, what kind is suspected – disorders in thyroid function: hyperthyroidism or hypothyroidism; disorders in anatomical structure – malignant or non-malignant nodule/s or mass/es.   One has just have to process the data obtained from the physical examination.

To be able to process the data intelligently with the aim of coming out with a physical diagnosis, first, one has to know the potential diseases affecting the thyroid gland (at least the common ones); second, the signs if present that are suggestive of a particular thyroid disease; and third, the diagnostic processes usually being used (pattern recognition and prevalence; diagnosis by exclusion; etc.)

The potential diseases affecting the thyroid gland can be categorized (for simple and practical purpose) into disorders in thyroid function and disorders in anatomical structure.  Disorders in thyroid function are hyperthyroidism and hypothyroidism.  Disorders in anatomical structure can present with diffuse enlargement or nodule formation.  Those presenting with nodule/s or mass/es are usually either malignant or non-malignant.  Those presenting with diffuse enlargement are usually benign condition such as hyperthyroidism, hypothyroidism, and diffuse colloid adenomatous goiter.

The common malignant thyroid nodule/s or mass/es are papillary carcinomas; follicular carcinomas; medullary carcinomas; and anaplastic carcinomas.  The common non-malignant disorders presenting with nodule/s or mass/es are colloid cysts; colloid adenomatous nodules; multiple colloid adenomatous goiter; follicular adenomas; and thyroiditis (acute and chronic).

After knowing the potential diseases that may affect the thyroid gland, one must know their usual presentation in terms of sign data (if one is after physical diagnosis).  It is recommended that one must know also the usual presentation in terms of symptom data as these are needed in the formulation of the clinical diagnosis.

See:

https://www.scribd.com/document/197140776/Clinical-Diagnosis-of-Thyroid-Disorders-A-Self-instructional-Program-ROJoson-1992

See also the following:

Minimum Tools in Physical Examination and Physical Diagnosis of the Thyroid Gland

Inspection of the Thyroid Gland – Part 1 of the Physical Examination

Palpation of the Thyroid Gland – Part 2 of the Physical Examination

 


ROJ@18jun7

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ROJoson’s Notes on Terminal Cancer

Terminal Cancer

Definition:

Cancer that cannot be cured and leads to death. Also called end-stage cancer.

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/terminal-cancer


An advanced stage of a malignant neoplastic disease with death as the inevitable prognosis.

https://medical-dictionary.thefreedictionary.com/terminal+cancer






 

Early staged cancers

Advanced staged cancers

Terminal staged cancers

 

To be continued

ROJ@18jun4

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Different Physicians – Different and Same Outcomes of Medical Care

This is a reality.

Patients being treated by different physicians will end up with different or the same outcomes of medical care.

This reality is illustrated in this slide.

Different Physicians – Different and Same Outcomes


ROJ@18jun3


Different Physicians – Different and Same Outcomes

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Correlation of all patient data and information to come out with a working diagnosis

us_fibrocystic_2_batangas_17oct10


ROJ@18may28

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Laypeople’s approach on how to “interpret” reports of mammography – some tips

First written in August 6, 2017; updated – May 27, 2018

Mammographies or x-ray of the breasts are being done frequently.  Patients have copies of the reports and try to look or even “interpret” what are written or stated there.  One output or scenario of patients’ “interpretation” is that they are not bothered by what are stated or written because they claim they do not understand them and would rather wait for a breast specialist’s explanation or interpretation.  This is a good and best stance – let a breast specialist explain and interpret the reports or the statements in the reports.  The breast specialists correlate (they should) whatever statements or phrases seen in the reports with the physical examination findings (they should do physical examination of the breast and not just rely on the radiologist’s findings) and decide which are significant and which are not significant findings and whether to follow or not to follow the recommendations made by the radiologists. There may be reports of something like presence of more than one-centimeter nodules or masses on mammography but which are not seen on physical examination (usually breast nodules or masses 1-cm or more should be palpable by a breast specialist).  In such situation, the breast specialists have to decide what to do, with the options of repeating the mammography; request for a different diagnostic tests on the breasts such as ultrasound or magnetic resonance imaging; or just wait and watch with repeat physical examination of the breast at another time, such as one month or at planned intervals.  There may be reports of something like presence of microcalcifications that are suspicious of malignancy.  The breast specialists have to take a look at the mammographic plates and scrutinize the microcalcifications reported by the radiologists and decide whether they are significant or not; whether they are highly suspicious for malignancy or not; or whether they should do needle-localization biopsy or not as recommended by the radiologists.  A lot of times, mammography reports contain such a phrase: BIRADS 0 – needs additional examination even though there are no architectural distortion, discrete mass lesion, and suspicious microcalcifications seen.  Most of the time, ultrasound of the breast is the additional examination recommended.  The breast specialists have to decide on this.  If the mammogram report there are no architectural distortion, discrete mass lesion, and suspicious microcalcifications seen and the physical examination done by the breast specialists show no abnormal findings, particularly no dominant mass, there is usually no need to have additional examination.

Another output or scenario of patients’ “interpretation” is that they are bothered by what are stated or written because they look alarming such as presence of nodules; presence of multiple nodules; presence of calcifications, both macrocalcifications and microcalcifications; BIRADS reporting, such as BIRADS 0 – needs additional examination and BIRADS 4 – suspicious for malignancy; and presence of a recommendation to do a biopsy.  In such a scenario, the advice is to see a breast specialist right away for proper interpretation and recommendations, one to allay undue fear and anxiety which may not be necessary because it may turn out there is no problem afterall.  Second, to be helped in deciding whether the radiologists reports (findings and recommendations) are valid or not.

Important take home tips:

Whatever be the report of the mammograms, consult a breast specialist right away for proper interpretation, explanation and recommendations.

Since mammograms in the Philippines and probably in other countries frequently contain BIRADS 0 – needs additional examination even though there are no architectural distortion, discrete mass lesion, and suspicious microcalcifications seen, consult a breast specialist right away proper interpretation, explanation and recommendations.  He / she will make the necessary recommendations whether an additional examination is needed or not.

For all mammogram results, there must be a clinical correlation, meaning comparison of the mammogram results with the clinical findings and other available data  This phrase is usually seen in all mammogram reports.


ROJ@18may27

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