Clinical dialogue five

1
Clinical dialogue five

• Xiao Xiong Li
• Department of neurological Surgery
• Ren Ji Hospital

2
Part one

• D I see from your notes you were in hospital 10
  years ago with thyroid trouble.
• P Yes, thats right.
• D What has actually been happening since that?
• P All sorts of things. Ive been feeling very
  depressed for a year.
• D Did you go to your doctor?
• P Yes, he gave me some Valium tablets to slow me
  down but they slowed me to a halt. I did nothing
  but sleep.

3

• D Did they affect you in any other way?
• P Yes, I got stomach trouble, maybe indigestion,
  I think.
• D What symptoms?
• P All the food stays up here. (indicating chest)
• D When do you get it?
• P Two to three hours after food.

4

• D Burning or stabbing pain?
• P It feels like some wind there and I want to
  get rid of it.
• D Do you belch?
• P Not much.
• D Does it bother you at night?
• P No, it comes on when I was hungry and I feel
  Ill collapse if I dont eat straight away

5

• D How about your appetite?
• P Very poor, it started to deteriorate 10 years
  ago.
• D What about your weight?
• P Im loosing weight.
• D What about your bowels?
• P Im constipated.

6

• D How often do you have them opened?
• P Only when I take medicine.
• D Every day?
• P No, every other day.
• D Do you always sweat?
• P Yes, but more recently.
• D All over you body?
• P Yes, all over.

7

• D Any depressed , nervous, edgy, irritable?
• P Yes, it started one month ago before I got my
  job.
• D Periods regular?
• P Every month since I had my baby five years
  ago.

8

• D Is there anything else youve noticed ?
• P No.
• D Has anyone in your family had thyroid trouble?
• P No, I have one sister and two brothers, they
  are well.

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Part two

• D I see youve been anaemic and you had a blood
  test last May. Has anything else trouble you?
• P Ive kept getting a roaring in my ears and
  giddiness.
• D All the time?
• P Most of the time.
• D How long has all this gone on?
• P Say, about six months.

10

• D Since your treatment with iron?
• P Yes, I keep getting dizzy spells.
• D Does anything bring them on?
• P Rushing about. Sometimes I know Im falling
  but I cant stop myself.
• D Do your legs give way?
• P Yes.
• D If you stand still, do you hold on?
• P Yes.

11

• D Are you all right between spasms?
• P Yes.
• D Does it affect your ears?
• P I get roaring in my ears.
• D How long?
• P Minutes.
• D Do you feel sick?
• P Yes, first thing in the morning. Terribly.

12

• D Do you suffer from headaches?
• P My periods are only half a day and I get
  terribly headaches.
• D How often do you have your periods?
• P It varies, every two or three weeks.
• D Is it always like that?
• P Yes.
• D You say you are breathless?
• P Yes, I get puffed if I go upstairs.

13

• D Do you have any bowel trouble?
• P No.
• D Water?
• P No.
• D Do you get up at night?
• P No.

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Part three

• D I see from your notes you came to us a year
  ago with an overactive thyroid gland.
• P Yes, and I had a miscarriage in May and Im
  now pregnant again.
• D When is your baby due?
• P Roughly 10th July.
• D Have you been taking pills for your gland?
• P I stopped about six months ago.

15

• D How are you at the moment?
• P I keep feeling queer and my doctor suggested I
  had a check-up.
• D Do you ever faint?
• P No, but I feel faint.
• D Do you actually flush or sweat?
• P No, not as before.

16

• D Have you been gaining weight?
• P Yes, I didnt realise I was pregnant.
• D Are your bowels regular?P Yes.
• D Do you go more than once a day?
• P No.
• D They are quite well-formed, are they?
• P Yes.

17

• D How are your nerves? Are you jittery, fidgety?
• P No.
• D Do the family get on your nerves?
• P Not now.
• D Were your eyes always prominent?
• P Yes.

18

• D Are you particularly bothered by weather?P
  No, I used to be before.
• D You suffer from palpitations?
• P Yes, but Ive had them since I was a child.
• D In yourself, you feel different?P Oh, yes.