Mammography-special x-ray study breast cancer- cyst, lump

Mammography-special x-ray study -is usually reserved for special situations. Mammography is often more accurate than physical examination but less accurate than biopsy. A skilled radiologist is needed to read these x-rays. 

Newer radiological techniques promise to make the x-rays easier to read and may help to make the test more feasible for screening purposes. Mammography often helps in cases where the physician feels that the lump is not cancerous but would like additional supportive evidence. It is also employed when many cysts are present in a breast, making it difficult to detect a new mass. Mammography often is helpful when a lump is difficult to feel and outline clearly, or when there is persistent pain in one breast.

It is often used routinely for women who have a strong family history of breast cancer or who have had a cancer removed from one breast, since they may have a higher-than- average risk of developing breast cancer. Many women between the ages of 30 and 50 have benign cystic disease of the breast. The condition is characterized by dilatation and cyst formation in the glandular tissue, perhaps connected with estrogen secretion. 

There does not seem to be any relationship between cystic disease and cancer development, but many physicians will not prescribe estrogen-containing medications (such as birth control pills) for women with cystic disease, because there is a tendency with such medications for the cysts to become larger and more numerous, making cancer more difficult to detect. The most common lump in the breast of a woman less than age 30 is a fibro adenoma. This is usually an isolated and well-demarcated lump. It may grow to large size and cause pain.

Treatment is removal of the mass to make certain that it is not cancerous. Early detection and prompt treatment are vital for winning out over cancer of the breast. If the cancer is removed before it has spread to local lymph tissue, the five-year cure rate is 75 to 90 percent; e.g., 75 to 90 percent of patients are alive and well at the end of five years.

 If removed after such spread, the cure rate is in the 50 percent range. At present, the recommended treatment is radical mastectomy-removal of all breast tissue and adjacent lymph nodes. Most women withstand the surgery well. 

HOW MUCH TO EAT - A word about food

FOOD CAUSES

It is better to eat no more than eighty per cent of your capacity. A Japanese proverb has it that eight parts of a full stomach  ache sustain the man; the other two sustain the doctor."

So one of the Zen masters is quoted in the book Three Pillars of Zen (Beacon Press, Boston, 1967)

The advice is relevant. That Americans generally consume too many calories for the amount of physical energy they expend is a matter of record and of increasing concern as the energy expenditure tapers off even more. Every five years, the National Research Council, which serves as scientific adviser to the United States government, publishes recommended dietary allowances.

After recommending, in 1963, a cut of 100 calories per day for men and women, it recommended another 100-calorie reduction in 1968. In its calculations, the Council uses a "reference" man and woman-each 22 years old, weighing 154 pounds and 127 pounds respectively, living in a mean temperature of 68 degrees, and engaging in light physical activity. 

Such a man, the Council now figures, needs 2,800 calories a day; the woman 2,000. The Council also recommends that caloric intake be cut below these levels with age-by 5 percent between ages 22 and 35, by 3 percent in each decade between 35 and 55, and by 5 percent per decade from 55 to 75.

This brings the figure for the woman, for example, to 1,900 by age 35, to 1,843 by age 45, to 1,788 by age 55, to 1,699 at 65 and to 1,614 at 75. These, of course, are general guidelines, leaving room for individual variations, and your physician may well have suggestions of value for you. It is a measure of good health, and a contribution toward maintaining it, to reach and keep a desirable weight. 

For that, an effective balance between food intake and energy output is needed. If you are currently at ideal weight (see table on page 61), your intake and output are in balance---which is fine if you are getting adequate amounts of exercise. Exercise, of right kind and in adequate amounts, is a vital element in health for many reasons (see Chapter 8). If you should need to increase your physical activity, you will need to increase intake to maintain desirable weight.

Penicillin overdose side effects! How to avoid it?

A Special Word about Medicine Taking of many people that if a little is good, more is better. With potent agents, excessive dosage can produce real trouble. Similarly, under dosage can cause problems. Inadequate antibiotic dos- age, for example, carries its own risk. One common example is the patient with a "strep" throat who takes penicillin, improves, stops treatment, then gets the sore throat back again.

Once more, he takes some penicillin but not the full prescribed amount. Again the sore throat dis- appears only to recur after a short time. And so a disease that can be eradicated by continued administration of penicillin for eight to ten days is converted into one that drags on with repeated remissions and relapses. Physicians have, in fact, long suspected that many failures of anti- biotic treatment stem simply from failure of patients to keep taking medication as prescribed. A recent study uncovered disturbing evidence that many parents may be risking their children's health by failing to make certain they take their medication as long as necessary.

Actually, in acute "strep" infections, penicillin treatment for 10 days is considered essential to prevent rheumatic fever. Yet in a follow-up of 59 children for whom a 10-day course of penicillin had been prescribed, investigators found that 56 percent of the youngsters had stopped taking the drug by the third day, 71 percent by the sixth day, and 82 percent by the ninth day. When a doctor prescribes medication, the first thing to do is to get the prescription filled immediately. The value may be lessened, or even lost completely, if you delay.

Then follow directions of the doctor to the letter. If you are not certain you understand them, ask him for clarification-even for instructions in writing as to exactly what you are to do. Take all the medicine pre- scribed, not some amount you arbitrarily settle on. Don't decide, if you begin to feel better, that you can stop or reduce dosage. Sometimes, illnesses require several prescriptions. Very much worth noting here is an old principle taught to nurses: read every label three times. You can use that principle to advantage at home. 

Modern Medicines is One of Major Successes, But it Also Includes Disasters

A SPECIAL WORD ABOUT MEDICINE TAKING 

THE HISTORY of modern medicines is one of major successes, but it also includes disasters. Tremendous benefits have followed the discovery of insulin for diabetes, agents for controlling high blood pressure, antibiotics and other anti-bacterial that kill or impede the growth of bacteria, cortisone and other steroid compounds that combat inflammation, tranquilizers and antidepressants for nervous and mentaldisorders, and drugs that slow the wild growth of some cancer cells. But there have been tragedies traceable to indiscriminate use and abuse of such powerful agents and of others. For one thing, no medication yet developed is fool proof-universally useful for even the condition for which it was developed, free of undesirable effects.

Virtually every drug, just as virtually every food, may produce unpleasant effects for at least a few individuals, and so it must be used with care. We hope in this chapter to provide a useful guide to medicine taking, one that will be helpful to you both in more effective treatment of any health problems that arise and also in preventing many problems. 

PRESCRIBING FOR YOURSELF 

A recent survey of a small but typical group of households carried out by a major university research institute found that the number of medications on hand varied from 3 to 88, with a mean of 30. Of the 2,539 medications observed, only 445 were prescription drugs. Each month in the United States, 750 out of every 1,000 adults 16 years of age and over experience a cold, headache, or other illness or  injury for which only 250 will consult a physician.

Thus, people control their own care in terms of whether and when to seek medical aid and when to prescribe for themselves. Virtually everyone on occasion does his own prescribing-and that can be a practical matter. Certainly every minor ache or pain does not require that a doctor be called. Nobody wishes to become a habitual patient. The medicines-variously known as "patent," "proprietary," and "over-the-counter" or "OTC"-which you can purchase in drugstores without a doctor's prescription are generally milder and have fairly broad safety margins. 

Fever : Temperature to measurement and prevention of diseases

 If there is a severe chill or a rash, then no matter how mild the temperature elevation, medical help is needed. A stiff neck, even if the fever is slight, may be an early indication of meningitis. A fever that develops after an accidental cut or other injury which could have become infected may mean blood poisoning (septicemia). 

When a fever, even mild, is accompanied by nausea and pain in the abdomen, especially in the lower right part of the abdomen, the problem could be appendicitis. Appendicitis often progresses rapidly, and whereas it can be treated effectively early in its course, it may become a major problem if neglected for even a few hours. One final note about slight fever: If you have a chronic disorder such as rheumatic heart disease, asthma, diabetes, or nephritis, your physician may warn you to let him know the minute you discover a fever or even a common cold coming on.

PAIN

All of us have occasional headaches. And there are mild and fleeting aches and pains from unaccustomed exertion and even family arguments and business or other anxieties. These are certainly no medical emergencies. But any new or unusually acute pain in the chest or abdomen should call for medical consultation. Pain in the chest accompanying exertion may be due to heart trouble-but not invariably. Pain at its worst when you take a deepbreath may be due to pleurisy. Chest pain that develops upon bending over after eating may be due to a hernia of the diaphragm. Many relatively mild abdominal pains are associated with gas in the bowel; some stem from constipation; some are associated with fatigue, depression, or anxiety. 

Sometimes, aches and pains that appear to be originating inside the abdomen or chest are actually coming from the abdominal or chestwall as the result of fibrositis of muscles. Peptic ulcer pain usually comes with hunger and is relieved by food or an acid- neutralizing agent. Gallbladderpain often starts under the lowest right ribs in front and runs up under theright shoulder blade. 

How often periodic medical checkups should be carried out?

How often periodic medical checkups should be carried out is best determined by the physician on the basis of what is most suitable for you as an individual rather than on the basis of a general rule. Age is one determinant. The elderly and the very young generally need more frequent examinations than those in between. But other factors must be considered-present state of health, past medical history, family medical history, occupational hazards if any, etc. Your physician will take these into account in deciding what is most appropriate for you -a checkup once a year, or twice a year, or perhaps once in two years.

BETWEEN CHECKUPS Manifestations of illness or impending illness take the form of signs or symptoms, or both. Signs are objective evidence: for example, a change in skin color or the swelling of a body part. Symptoms are subjective: for example, nausea or pain.

They can vary greatly, of course, from mild' and fleeting to severe and persistent. All deserve attention, though it is likely that if they are mild and transient the reason for them is inconsequential. Any persistentor recurring sign or symptom deserves action. Even if mild it should not be ignored. Passing it off as something not worth notice except by a hypochondriac is dangerous.

 You may become so habituated to its presence that you regard it as something "normal" for you-until the underlying problem reaches a stage where it is irreversible or leads to serious consequences. The following discussion is intended to help you interpret the significance of signs andsymptoms that may appear between checkups, as a guide to when to consult your physician without delay. 

How AUTOMATED MULTI-PHASE SCREENING helps to check diseases in health care

One of the relatively recent developments that is almost certain to bring striking changes in the practice of medicine, adding further to the emphasis on and practicality of preventive medicine, is automated multi- phase screening. The idea is to link electronic detection devices, large numbers of chemical tests, and computer science together to screen or check, at low cost, large numbers of apparently healthy people, looking for the most subtle signs of early disease and even of pre-disease states, doing far more routine testing than physicians have time for, providing them with the results of the tests, and giving them more opportunity to counsel patients and practice preventive medicine.

In a periodic checkup that may run two to three hours, a patient moves from one station to another for checks of hearing, visual acuity, respiration rate, lung capacity. An electrocardiogram is made; a measurement of pressure within the eye is quickly made for detection of glaucoma, a major cause of blindness. A chest x-ray is taken and, in the case of women, a three-dimensional breast photograph (mammography). Pulse and blood pressuremeasurements are included. The patient answers a self-administered questionnaire on health history. And blood and urine samples are taken and automatically checked for indications of infection, gout, diabetes, and other diseases and also for a variety of biochemical values that may give some indications of pre disease changes. A computer summarizes the findings and produces a printed record for the patient's personal physician to evaluate. Automated multiphase screening is moving rapidly out of the experimental phase. Much of the pioneering work in its development was done by physicians at the Kaiser Foundation Health Plan in northern California with some financial assistance from the U.S.Public Health Service

The Public Health Service has awarded funds to set up pilot programs in Milwaukee, New Orleans, Brooklyn, and Providence-some affiliated with health centers in poverty areas, others with universities, and still others with city health departments. Already, some large industries are planning automated multiphase screening facilities as part of their occupational health programs. And there are plans for forming medically directed private companies which would provide automated screening service for patients referred by physicians.

Automated screening facilities may not be available in your community yet. Ask your doctor about them. Tell him you are interested. If the facilities are not available, you will be doing a public service by encouraging your doctor to push for their establishment in the near future.

YOUR ROLE

You AS the patient in preventive medicine have a role to play that goes far beyond cooperating in regular checkups. You can build and maintain your health, taking advantage of the latest knowledge in such areas as nutrition, weight control, physical activity, rest and relaxation (to be covered in later sections of this posts). You can be alert, too, between checkups for any danger signals.