Clinical dialogue five

Xiao Xiong Li

Department of neurological Surgery

Ren Ji Hospital

Part one

D: I see from your notes you were in hospital 10 years ago with thyroid trouble.P: Yes, that’s right.

D: What has actually been happening since that?P: All sorts of things. I’ve 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.

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.

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 I’ll collapse if I don’t eat straight away

D: How about your appetite?P: Very poor, it started to deteriorate 10 years ago.

D: What about your weight?P: I’m loosing weight.

D: What about your bowels?P: I’m constipated.

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.

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.

D: Is there anything else you’ve noticed ?

P: No.

D: Has anyone in your family had thyroid trouble?

P: No, I have one sister and two brothers, they are well.

Part two

D: I see you’ve been anaemic and you had a blood test last May. Has anything else trouble you?P: I’ve 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.

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 I’m falling but I can’t stop myself.

D: Do your legs give way?P: Yes.

D: If you stand still, do you hold on?P: Yes.

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.

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.

D: Do you have any bowel trouble?

P: No.

D: Water?

P: No.

D: Do you get up at night?

P: No.

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 I’m 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.

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.

D: Have you been gaining weight?P: Yes, I didn’t 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.

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.

D: Are you particularly bothered by weather?P: No, I used to be before.

D: You suffer from palpitations?

P: Yes, but I’ve had them since I was a child.

D: In yourself, you feel different?P: Oh, yes.