Common Health and Medical Questions and Answers. This health blog contains the questions that I've been most often asked by the patient facing surgery, his immediate family or concerned relatives.
What is a radical neck dissection?
The surgeon removes a block of tissue from the collarbone to the jaw and from the front to the back of the neck. The large muscle on the side of the neck that is used for rotating, flexing or extending the neck is also taken out, along with the major vein on the side of the neck. Sometimes, a less drastic operation, called a supraomohyoid neck dissection is done. This takes out only the lymph nodes, the tissue surrounding the nodes and a muscle at the front of the neck. Another technique, called a functional neck dissection, saves the muscles of the neck, taking out only the lymph nodes and tissues surrounding them. What kind of incision is made with a radical neck dissection?
The incision depends upon what the surgery is for. It can run from below the ear to the collarbone. Everything in the front of the neck on one side or on both sides may be removed. This may include the lymph nodes, blood vessels, nerves, and the salivary gland under the jawbone.
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Why is lymphangiography important in the diagnosis of cancer?
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Lymphangiography is important to cancer diagnosis because one of the ways that cancer spreads is through the lymph nodes. Lymphangiography can be useful in the diagnosis and staging of persons with Hodgkin's disease and lymphomas and sometimes for other cancers. It is a procedure which is done in an outpatient setting or in a hospital. A blue dye is injected into the small lymph vessel after a cut is made in the big toe. The lymph system in the abdomen can then be looked at by means of x-rays. Since the lymph glands are very small, it usually takes 2 to 3 hours for the dye to reach the lymph nodes. Lymphangiography is used to localize and determine the extent of the tumors. The surgeon can use it as a guide to finding specific lymph nodes and determining the size of the tumor. The radiotherapist uses it to evaluate how a person is responding to therapy. Since the dye stays in the system for some 3 to 4 months, progress usually can be followed through x-rays without repeating the procedure.
Do some of the parts of the body absorb more x-ray beams than others?
If you put a part of the human body in front of a beam of x-rays, some of the rays will pass through, while others will be absorbed and scattered inside the body. Bone, for example, which is more dense, will absorb x-rays more readily than surrounding tissues. It is the shadows of these denser parts of the body which show up on the developed film or screen.
What kinds of contrast media are used for x-rays?
X-rays are absorbed by dense substances such as barium or iodine. These contrast media can be swallowed, injected into the bloodstream, or inserted with a plastic tube or catheter. Sometimes dye and air are both used in contrast films. For example, often both barium and air are used for gastrointestinal examinations.
What kind of physician should read diagnostic x-rays?
Diagnostic x-rays should be interpreted by doctors who are board certified (or board eligible) radiologists.
What kind of background does a radiologist have?
A board certified radiologist (certification is by the American Board of Radiology) must be a graduate of an approved medical school; must have four years of postgraduate training in the department of radiology, including training in pathology, nuclear radiology, and therapeutic radiology; and must have successfully completed written and oral examinations administered by the board.
What is the difference between a diagnostic radiologist and a therapeutic radiologist?
A diagnostic radiologist administers and interprets x-rays used in diagnosing illness. A therapeutic radiologist (also sometimes called a radiation therapist, a radiotherapist, or a radiation oncologist) specializes in treating cancer with radiotherapy. The American Board of Radiology gives separate certification to these two specialties.
How do I know where to go for my diagnostic x-rays?
This is a subject you should discuss with your physician. Ask questions. If you can, have your x-rays done in the outpatient department of a medical school or major hospital or by a private board certified radiologist.
What questions should I ask before I have x-rays?
You should ask the following questions:
• Are the x-rays clearly necessary for diagnosis?
• Are there any x-rays which I have had taken recently which might be used instead of taking new ones?
• What is the approximate dose of x-ray?
• What do you think you will find out from the x-rays?
• What dosage is the particular machine giving?
• When was the machine last inspected?
• What kind of shielding will be used during the procedure?
Is there really a difference between the machines used in one office and those in another?
Yes, there is definitely a difference. You should know that both the quality of the x-ray equipment and the quality of the technician or doctor doing the x-ray make a difference in whether or not you receive a low or high dose of radiation. The expertise of the operator also makes a difference in how good the x-ray will be. Another variable is in who reads the x-ray after it is taken.
What kind of training do x-ray technicians have to have?
There are some states which legally require that radiology technicians be trained and certified. The 1970 X-ray Exposure Study conducted by the Public Health Service shows that those x-rays supervised by radiologists in private offices involved less exposure than those supervised by nonradiologists in private offices. However, many states have been working with the FDA's Bureau of Radiological Health on radiation-control regulations and on training programs for personnel.
Are the machines inspected regularly?
There are presently no U.S. government inspection requirements. Although some states do have requirements, in many states the equipment is not inspected every year. Some machines, particularly those in doctors' offices, go uninspected for long periods of time. There should be a certificate posted near the machine. Look at it to see when the last inspection was performed. If it was more than a few years ago, go elsewhere.
When should x-rays be considered a necessity?
As noted earlier, x-rays are an important part of the diagnostic workup. When properly taken and read, they are one of the doctor's most valuable tools. However, the benefits of the x-ray must be weighed against the risks. A qualified professional is a better judge of when x-rays are needed than you are. You, however, need to know the right questions to ask so that you can assure yourself you are in the hands of a skilled and competent practitioner.
What is the major risk of diagnostic x-rays?
The amount of radiation which x-rays deliver to your body is the biggest risk. It is believed that the risks of x-ray dosage are linear that is, the more dosage a person receives during a lifetime, the greater his or her chance of developing cancer or another abnormality.
Who can tell me what the approximate dosage should be for the various tests?
Your doctor should be able to give you approximate dosages so that you can ask the technician where you are having the test done what dosage his machine is giving. For example, a standard chest x-ray involves between 5 and 10 millirem (.005-010 rem or rad); a mammogram should be under 1 rad for both pictures of each breast.
Do the x-rays belong to me?
There is quite a bit of controversy over this issue. However, you have a right to ask that the x-rays taken in one place be sent to another doctor or hospital of your choice. Some doctors and hospitals will give them to you directly; others will insist on mailing them to the other physician or hospital. It might be a good idea to explain that you are concerned about x-ray overexposure.
What is malignant melanoma?
Malignant melanoma is a less common form of skin cancer. When diagnosed early, it is easily cured. But if it is not found soon enough, it can be very difficult to treat. It is dangerous because, unlike the other skin cancers, it mestastasizes early and spreads quickly. It is one of the more uncontrollable cancers. The cell involved is the melanocyte, the cell which produces melanin, the dark protective pigment of the skin. What is the difference between an ordinary mole and melanoma?
An ordinary mole is evenly colored, and either brown, tan or black. It may be flat or raised. It is round or oval and its edges are sharply defined. An ordinary mole is usually less than 6 millimeters in diameter about the size of a pencil eraser. Ordinary moles may be present at birth. Sometimes several appear at the same time, usually on areas of the skin which have been exposed to the sun. Once the mole develops, it usually stays the same size, shape and color for many years.…
Yes. After prostatectomy, the ability to ejaculate through the penis is lost. What happens is that ejaculation occurs but it is directed backward into the bladder, rather than forward through the urethra. The semen remains in the bladder until urination, and is carried out via that route. The man who ejaculates in this manner has the very same sensations during sex that he had before except that there is no discharge through the penis. Can a total prostatectomy be done without impairing the ability to have an erection?
Dr. Patrick C. Walsh, a surgeon at Johns Hopkins University Hospital in Baltimore, Maryland, has developed a way of removing the prostate which preserves potency by bypassing the intricate nerve branches of the pelvic plexus. This technique is now being adopted by many surgeons for patients with early stage prostate cancer. Until the advent of this type of surgery, 90 percent of those having prostatectomies lost their sexual ability, and 2 to 5 percent became incontine…
Fractures of the AnkleHow do ankle fractures occur? Ankle fractures are caused by a forceful and excessive
twisting of the ankle, either in or out. The twist comes
from stumbling, catching the foot in a crevice, or falling,
in which the weight of the body is unevenly distributed.
Many skiers suffer fractured ankles, and some of the best
treatments have been evolved by surgeons practicing near
ski slopes. The stress and strain factors in the ankle are
so uniform that the pattern of the injury, dislocation and
deformity is specific. Many varieties of ankle fractures are
grouped together under the name of Pott's fracture.
What shall I do, Doctor? I'm at a gas station phone and
my wife just fell down and twisted her ankle.
If it is painful and she can't walk, it may be a fracture.
Don't manipulate it, don't pull it. Just wrap a towel or
pillow around it and take her to a hospital for an X ray.
It is best if she does not walk. You can carry her in a
chair. How does an an…
What is a bone marrow transplant?
Bone marrow transplantation is an approach used over the past 10 years for the treatment of acute leukemia and lymphoma. It is a complex procedure and should be undertaken only by physicians with the experience and resources needed to get the best results. When is a bone marrow transplant used?
It may be used in some cases of several types of diseases aplastic anemia (when patients do not have enough red cells to carry oxygen, enough white cells to fight bacteria, or enough platelets to help clotting), in some types of acute and chronic leukemia, for some lymphomas, for severe combined immunodeficiency syndrome, and for certain inherited blood disorders such as thalassemia. A bone marrow transplant replaces a patient's abnormal or diseased marrow with healthy marrow from a donor. Can any leukemia patient undergo a bone marrow transplantation?
No. When patients and doctors consider the possibility of treatment with a bone marrow transplant, they m…
Head Injuries
The brain is man's most vital possession. Recent
details about organ transplants have centered on the
definition of death. These discussions have emphasized
that, even though the heart may continue to beat, the
individual is considered dead if there is no brain activity.
Nature provides a thick scalp and skull to protect the
brain and further encloses it in envelopes called the
meninges. Some injuries to the head may be trivial, others
may be fatal.
The surgeon who is called upon to evaluate the patient
with a head injury tackles the problem from within out.
Damage to the brain and its envelope is most important;
injury to the skull is of concern in only some instances.
Bleeding from the scalp is the most apparent manifestation
of injury but is the least important. Survival and
the late effects of a head injury depend on the extent of
the injury to the brain and not to its coverings. The
best possible supportive medical crre is provided to
those who will recover spon…
Would the doctor prescribe estrogen if my ovaries were removed because of cancer?
No. If there is any sign of a cancerous condition, estrogen would probably not be prescribed. What is the estrogen controversy?
Estrogen is a female hormone produced by the ovaries. Scientists have also developed chemical estrogen. Both regulate the development of female sexual characteristics. For a number of years, estrogens have been prescribed for women during and after menopause to make up for the decline in this hormone normally produced by the ovaries. Estrogen has been found helpful in relieving symptoms associated with menopause, such as hot flashes, in overcoming drying of vaginal tissues and in retarding osteoporosis (thinning of bones). However, the use of estrogen during and after menopause has been linked to an increase in endometrial cancer (cancer of the lining of the uterus), and it may be linked to other cancers as well. At this time,scientists do not agree about whether the risks of …
Chest Injuries
The chest consists of the bony thorax and the organs
that lie within it. The thorax comprises twelve ribs on
each side of the chest, each of which attaches to the bony
spine in the back and to the chest bone (sternum) in
front. Each chest cavity has a smooth delicate lining
(pleura) within which the lung rhythmically expands and
deflates.
The diaphragm is the dome shaped muscle that seals
off the lower end of the chest from the abdomen. Its upand down motion provides the bellows action for the
expansion of the lungs that fills them with air. The function
of the lungs is to provide ventilation. Air is moved
in to provide oxygen, and carbon dioxide is moved out
as a waste product.
The heart is in its own envelope in the center of the
chest, behind the breastbone. The heart functions solely
as a pump. It circulates the blood into the lung for oxygenation and delivers oxygenated blood to the entire
body. The chest also harbors the large blood vessels and
the breathing and s…
In the radical mastectomy (also known as the Halsted mastectomy) the doctor removes the breast tissue, the lymph nodes under the armpit, and the muscle under the breast. The modified radical, which most surgeons are now using, removes the breast tissue and the lymph nodes, but the muscle is left intact. The advantage of the modified radical is that it is cosmetically more attractive and does not handicap the motion of the arm. Studies indicate that the survival rate for the two operations is the same. Is the choice of what surgical procedure I will have up to me or up to the doctor?
Of course your doctor is responsible for the surgery. But he cannot perform any operation unless you give your signed consent to have it done. You should have your doctor give you his complete explanation of what he recommends as his bestjudgment and ask him all the questions that concern you about the operation. Do not sign anything until you are certain you understand what you are signing. It is your righ…
Hodgkin's Disease and Non-Hodgkin's LymphomaWhat are lymphomas?
Lymphomas are cancers that affect the white blood cells of the immune system. They are characterized by the abnormal growth of lymphocytes, the infection fighting cells in the lymph nodes, spleen, and thymus. The tonsils, stomach, small intestine, and skin may also be affected. Lymphomas are usually classified as Hodgkin's disease, the most common form, or non-Hodgkin's lymphoma. There are also other rare forms of the disease, such as mycosis fungoides, a primary skin lymphoma. Burkitt's lymphoma, rare in most of the world, is the most common childhood cancer in central Africa and is one of the fastest growing human cancers. What is the role of the lymph system in the body?
The lymph system is made up of nodes and thin walled tubelike veins along which the nodes lie. Its job is to help fight diseases and infection, and it serves as part of the body's drainage system. Lymph nodes are usually very sm…
Hand Injuries
Most of us earn our living with our hands. The goal
of the treatment of hand injuries is maximum preservation
of function. In terms of possible permanent disability,
there is no minor surgery in this area. The magnitude of
the problem is apparent in the frequency with which it appears in the statistics of the Workmen's Compensation
Board and insurance companies.
The best treatment is prevention. One must be constantly
alert to the possibility of punctures, door slams,
burns, pressure injuries, and the perverse potential of
certain mechanical tools. Failing this, early treatment to
prevent infection is best. There are relatively clearly defined
methods of managing various types of injury. The
patient can describe the site of the injury by indicating
its relation to the various creases in the palm or to the
knuckles and nails on the back of the hand. Physicians can
treat all hand and finger injuries under some form of
nerve blocking anesthesia, so the patient feels abs…
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