A couple questions relating to pancreas
Posted By: Kathy on 2006-12-04
In Reply to:
Subject: A couple questions relating to pancreas
This is a patient with advanced pancreatic cancer. Here's the part I'm having trouble with. He was admitted to the hospital. "The patient did undergo attempts at [s/l ESRT or "e ester tee"?]. However, the tumor was protruding through the duodenum [s/l ambule] and common bile duct cannot be cannulated. He was determined to be unresectable and underwent a choledochojejunostomy, gastrojejunostomy, and enteroenterostomy for diversion." Whew! Any ideas?
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Couple of lab questions... sm
Subject: Couple of lab questions... sm
Can't catch what Mr. Mush-mouth is saying.
Postoperative serial white blood cell count demonstrated a stable white blood cell count at 11,900. s/l *hemansa* hemoglobin stable at 28.9 and 9.4.
Have a couple of questions, please sm
Subject: Have a couple of questions, please sm
Sorry, filling in for somebody and this doctor is really fast -
1. Patient takes a s/l plepharde of medications.
2. Patient still has constipation despite taking s/l Cerafac.
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Pulling my hair out - just a couple questions
Subject: Pulling my hair out - just a couple questions
This study is a right ilia-femoral ultrasound.
Is it ilia-femoral or iliac-femoral, and what about the hyphen?
ALSO......
I cannot figure out what he is saying here:
PROCEDURE REPORT: The abdominal aorta and right ilia-femoral (see above..) systems were S/L: insinated or instinated with a Doppler ultrasound transducer.
Thanks for any help!!
A couple questions regarding Cardiology/Hematology
Subject: A couple questions regarding Cardiology/Hematology
He does have some mild jugular venous distention (JVD). He does have a slightly positive patojugular reflex.
He does have a grade 1-2/6 murmur load on the lower left sternal border and apex. The lungs: He continues to have a few fine basaloreals on the posterior lower lobe. The abdomen is somewhat softer today, it is rounded.
Need help with the MR angiogram in mesage, couple of questions and maybe more :) sm
Subject: Need help with the MR angiogram in mesage, couple of questions and maybe more :) sm
the MR angiogram of the posterior circulation intracranially showed a variant circulation with prominent bilateral “fetal” origin of the PCAs and distal basilar and "P1 segmental" hypoplastic were absent.
A couple of questions regarding Cardiology/Hematology
Subject: A couple of questions regarding Cardiology/Hematology
Hi, sure hope this helps. I had that recently. It is he has a slight hepatojuglar reflux sometimes referred to as reflex but more correctly it is reflux. Also it is "He continues to have a few basilar rales in the posterior lobe."
I doubt it, as appendiceal is relating to the appendix and cystocele relating to the bladder.
Subject: I doubt it, as appendiceal is relating to the appendix and cystocele relating to the bladder.
relating to the stomach...
Subject: relating to the stomach...
The stomach also looks fairly redundant like one might see with somebody with gastric apnea.
Is there such as thing as gastric apnea or maybe even acne? I am unable to find anything on either one.
Here's another - Ultralite - relating
Subject: Here's another - Ultralite - relating
they could not perform a right upper quadrant ultrasound at that time, a CT scan was performed which showed no evidence of acute inflammatory process but _Ultralite__ did show renal calculi without obstruction
I am seeing on Google that this might be right but didn't think I was viewing reliable sites - some mentioned in chat room type settings, etc.
anuric??? relating to anuria - nm
Subject: anuric??? relating to anuria - nm
Maybe pancreas
Subject: Maybe pancreas
pancreas
Subject: pancreas
On microscopic description of the pancreas. It states~ Pancreas shows a normal lobular pattern with interlobular fibrofatty tissue shows no noteworthy change. That doesn't make sense to me. Is that how it should read? HELP
since you gave NO relating information a guess might be
Subject: since you gave NO relating information a guess might be
x
all I could find relating to this subject was dysarthria. nm
Subject: all I could find relating to this subject was dysarthria. nm
nm
Yes. Temporally --: of, relating to, or limited by time.
Subject: Yes. Temporally --: of, relating to, or limited by time.
Some examples:
neurological symptoms are temporally related to statins.
Determine if symptoms are temporally related to. work,
increase in pancreas?
In recent, increase in pancreas has responded with some improvement. As such, I would suggest that his diarrhea and difficulties are most consistent with pancreatic insufficiency.
Helpppp!
pancreas [s/l escavism] TIA!!
Subject: pancreas [s/l escavism] TIA!!
pancreas "divisum" ??
Subject: pancreas "divisum" ??
Langerhans islands are in the pancreas. nm
Subject: Langerhans islands are in the pancreas. nm
x
tumor of the pancreas, s/l leukanoma?TIA
Subject: tumor of the pancreas, s/l leukanoma?TIA
xx
pancreas exocrine insufficient??
Subject: pancreas exocrine insufficient??
just a thought.
pancreas acinarization ? acinus? WAG here.
Subject: pancreas acinarization ? acinus? WAG here.
There is a Brown's sign according to Stedman's ENT book and I saw it on Google relating to tym
Subject: There is a Brown's sign according to Stedman's ENT book and I saw it on Google relating to tympanographic documentation
I know this is too late, but you have it right. Ungual means relating to the nails, subungual is &#
Subject: I know this is too late, but you have it right. Ungual means relating to the nails, subungual is "under the nail".
Doc keeps saying s/l cervical cysts but we're in the pancreas.
Subject: Doc keeps saying s/l cervical cysts but we're in the pancreas.
Says it half a dozen times and it still sounds like cervical! Help!
How to type: pancreas after kidney transplant. Would it be:
Subject: How to type: pancreas after kidney transplant. Would it be:
pancreas-after-kidney transplant? Thanks.
It does s/l phrenic lesions, could that be correct in terms of anatomy, relating to diaphragm?
Subject: It does s/l phrenic lesions, could that be correct in terms of anatomy, relating to diaphragm?
scan revealed nodular s/l ace-ee-iss entry into the head of the pancreas
Subject: scan revealed nodular s/l ace-ee-iss entry into the head of the pancreas
Can't make out this word. Sounds like ace-ee-iss with the stress on ace. Here's the whole sentence. "A CT of the abdomen with contrast revealed nodular [ace-ee-iss?] entry into the head of the pancreas and the omental fat, which was felt to represent adenopathy or recurrent tumor." Any ideas? Thanks!
glucagonoma is a rare tumor of the alpha cells of the pancreas ?
Subject: glucagonoma is a rare tumor of the alpha cells of the pancreas ?
There are a couple...sm
Subject: There are a couple...sm
Here is a great site with a couple of choices that sound like your term.
http://www.suffolkobgyn.com/medicalTerms#G
a couple T's
Subject: a couple T's
tap water enema
theophylline olmamine enema
tranexamic acid enema
turpentine enema
A couple more....
Subject: A couple more....
he went on to have an aortic valve replacement with a "number tommy five" bioprosthetic valve as well as bypass "sinus tree" vessels
pseudo normal LV filling pressure with "chronkomittent" abnormal relaxation
Patient is New York Heart Association class III in the setting of ischemic cardiomyopathy and "he feels" compensated
beta blockers, carvedilol "a target dose", "aldolsol" inhibitor
THANKS!
I too would like to know a couple of shortcuts..
Subject: I too would like to know a couple of shortcuts..
such as, I end each letter from my doc with "Thank you for the referral of the patient." Sincerely, John R. Brown, MD JEB/trh. I know there must be a way to store this so that all I have to do is strike 1 key to end my letters, but I don't knave a clue how to do this. Anyone have any suggetstions? Thanks
a couple of thoughts
Subject: a couple of thoughts
First to address the issue of subcu - Joint Commission created a list several years ago that deals with this wording - and JC trumps BOS. From Joint Commissions List of Dangerous Abbreviations:
Abbreviation: S.C. or S.Q. (for subcutaneous)
Potential Problem: Mistaken as SL for sublingual, or "5 every"
Preferred Term: Write "Sub-Q", "subQ", or "subcutaneously"
As far as what the man was trying to express to you was his opinion that truncated words (partial words used to express a complete word) should be avoided. Trach is not a word. Trachea, tracheostomy, etc., are words. Alk is not a word. Alkaline is a word. There are also lab and other words that are commonly acceptable in their abbreviated form, such as INR, CPAP, MRI, etc.
There are acceptable abbreviations of certain words that are commonplace. For example, lab is widely accepted to represent laboratory. Exam is acceptable to represent examination. HIV is another example.
If you understand the difference between the use of an abbreviation and avoiding the use of truncated words, your work will reflect a much clearer intent of the dictation.
Your company needs to decide which side of the fence it wants to sit on, and it appears there may be some changes in your QA future. If this man is in charge of QA and you want to continue working there, you might want to begin taking note of what he is saying.
a couple of things......SM
Subject: a couple of things......SM
Jehovah's Witness
myoclonic gammopathy? not myoclinic
possibly *gammopathy*
*h* in Jehovah's Witness
couple of possibilities (sm)
Subject: couple of possibilities (sm)
If you're sure you're hearing "radio" that could be a "short-speak" way of saying radiograph.
Another possibility is RDI (respiratory disturbance index).
I have a couple of docs that do this. sm
Subject: I have a couple of docs that do this. sm
The terms sound similar anyway, and if they say them a little too fast, or there's a flaw in the sound, these words sound exactly the same.
But sometimes there's a clue in what's being tested, blood or urine, and/or the diagnosis.
Also, if you can slow the sound down a little, sometimes you can hear a slight difference, just enough to know it's one or the other.
If that doesn't help, the best thing would be to send on to QA. If they can't figure it out, the docs may become tired of blanks and learn to enunciate more clearly. How difficult could that be!
Sorry I can't be of more help, but maybe someone else has a foolproof way to tell.
I have a couple of docs that do this. sm
Subject: I have a couple of docs that do this. sm
The terms sound similar anyway, and if they say them a little too fast, or there's a flaw in the sound, these words sound exactly the same.
Is there a clue in the dx?
If you can slow the sound down a little, sometimes you can hear a slight difference, just enough to know it's one or the other.
If that doesn't help, the best thing would be to send on to QA. If they can't figure it out, the docs may become tired of blanks and learn to enunciate more clearly. How difficult could that be!
Sorry I can't be of more help, but maybe someone else has a foolproof way to tell.
There are a couple of possibilities. Context?
Subject: There are a couple of possibilities. Context?
Here are a couple of links for you to send them....
Subject: Here are a couple of links for you to send them....
http://72.14.253.104/search?q=cache:_yrLOF4eEkIJ:emcrit.org/pdf/Wound%2520Care%2520Syllabi.pdf+XAP+topical+pediatric&hl=en&ct=clnk&cd=13&gl=us (at bottom of page 8) Hope this helps...When the doc spelled it for me, it was for a laceration repair on a kid. But, if it's a dental block in the ER, they might be using ZAP for topical in the mouth. Was something that was really confusing for me at the time, which is why I tried to get some info on it.
Can we have a couple of lines from the report
Subject: Can we have a couple of lines from the report
so we'll know where he is?
New to ortho and have a couple words.
Subject: New to ortho and have a couple words.
s/l *jo-lie-tandis* pain with hyperflexion. (knee)
Negative s/l *feralmis* test. (wrist)
TIA!
Have heard it used a couple of times
Subject: Have heard it used a couple of times
Just another way to say serial cardiac enzymes, I believe
If he already gave you a couple, then it would be 'all other...' nm
Subject: If he already gave you a couple, then it would be 'all other...' nm
s
Thank You! That's it. He always swallows the first couple of letters when I need them the most.
Subject: Thank You! That's it. He always swallows the first couple of letters when I need them the most.
.
Can't understand a couple of words
Subject: Can't understand a couple of words
If you're transcribing a report about someone with sinusitis, and the doctor says the ___ are red and swollen (and it doesn't sound like nostrils or nares or membranes) what could it be? And in the PLAN if he says ___ fluids, rest, and follow up within 7 to 10 days....what could he be saying. It almost sounds like "Push fluids." Can anyone help? Thanks!
Depends on a couple of things
Subject: Depends on a couple of things
The first point would be the hospital's desires. They may or may not want abbreviations spelled out in a report. Also, usually if it's in a diagnosis somewhere, it almost always has to be spelled out, as most hospitals abide by the joint commission rule of no abbreviations. In a regular physical exam somewhere in the text of the report, most hospitals, clinics, etc., seem to want whatever abbreviations the doc may use, so in that case you would just leave it as it is (although this may differ in correspondence as some places prefer a more formal policy of no abbreviations in letters, so check account specifics).
couple of web sites in case you
Subject: couple of web sites in case you
can use them:
revolutionhealth.com/search
M.D. Anderson Cancer Institute, Houston
pathology.washington
bloodjournal.org
Thanks, she did it with a couple others, so that makes sense
Subject: Thanks, she did it with a couple others, so that makes sense
A couple of grammar rules are at play here
Subject: A couple of grammar rules are at play here
First of all, both got and gotten are correct forms of the verb get. However, got is a past tense or past participle depending on whether or not the word "has" or "have" is used in front of it. Gotten, however, is past participle and should be used with the word "has" or "have" in front of it.
It has gotten increasingly larger - okay. It gotten increasingly larger - not okay. It got increasingly larger - okay. It has got increasingly larger - okay.
So if your doc says it anyway but "It gotten increasingly larger", he is correct. It's simply a matter of preference. Brits don't generally use the word "gotten", and therefore, a lot of people think it is not a legitimate word, but it is.
Does he state 20 the first couple of days or does he give any time along with that? SM
Subject: Does he state 20 the first couple of days or does he give any time along with that? SM
If not, I would just type as dictated and maybe put quotations around it if you are certain of what he is saying. HTH
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