No. 1 Medical English Volume 10: Respiratory Conditions [10]

Table of contents :
Table of Contents
DIALOGUES............................................................................................................... 9
1. COPD ....................................................................................................................9
2. ASTHMA ...............................................................................................................15
4. PRODUCTIVE COUGH ...............................................................................................28
5. WHAT TO DO ABOUT SNORING ..................................................................................34
ANSWERS..................................................................................................................41
ROLE PLAY .............................................................................................................. 49
ASSESSING THE THORAX AND LUNGS ...............................................................................49
NASAL CANNULA (NASAL PRONGS) .................................................................................52
OXYGEN DELIVERY WITH A VENTURI MASK ......................................................................53
PURSED LIP BREATHING ...............................................................................................57
DIAPHRAGMATIC BREATHING ........................................................................................59
PERFORMING TRACHEOSTOMY CARE ..............................................................................61
LISTENING .............................................................................................................. 64
1. ASTHMA ...............................................................................................................64
2. CROUP ..................................................................................................................69
3. CYSTIC FIBROSIS (CF) ..............................................................................................73
4. EMPHYSEMA ..........................................................................................................75
5. PNEUMONIA ..........................................................................................................79
6. PNEUMOTHORAX ....................................................................................................83
7. PULMONARY EMBOLISM ..........................................................................................87
9. TUBERCULOSIS (TB) ................................................................................................93
10. ACUTE BRONCHITIS ...............................................................................................96
11. PNEUMONIA ........................................................................................................99
ANSWERS............................................................................................................... 104

Citation preview

Medical English Volume 10 RESPIRATORY CONDITIONS A Unique and Practical Course

Listening, speaking, reading, writing, and role-plays using everyday language in medical situations

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Students’ comments: I heard about Ms. Vichert’s medical English courses back in 2013 when I was looking for a comprehensive summer program in which I could not only expand my medical vocabulary but also practice the jargon used among health care professionals. Ms. Vichert’s three-month intensive program helped me better understand medical terminology in general and to master doctor/patient & doctor/doctor communications through extensive role plays, clinical simulations, listening activities etc. Starting from greeting a patient in the office to taking his/her history, from explaining his medical condition to ordering lab work, from making a diagnosis to breaking bad news, her unique program covered it all! Moreover, written texts were supported by life-like audio recordings that helped me get the hang of authentic conversations that take place between patients and health care providers in an Englishspeaking country. I had found more than I was looking for! Being an English language teacher myself, I got back to my country with lots of self-confidence and innovative ideas. Ms. Vichert’s uniquely designed 2

program inspired me and helped me set up a professional English for medical purposes program at university level. It took me a full three months in Vancouver, Canada to learn it all from the ground up. Now Ms. Vichert is offering a similar opportunity to everyone around the world in the comfort of their home via her books. Don’t miss the chance! Erdogan Erturkoglu Assistant Director Foreign Languages Department The English For Medical Purposes Program Bezmialem Vakif University, Istanbul, Turkey Much attention and care was given to every aspect of learning: vocabulary, grammar, pronunciation, comprehension, formal/colloquial approach, idiomatic expressions. Pikku is a lovely and amazingly energetic lady who well knows the world and its creatures! I believe every student should try this enriching experience, to improve spoken and written English and, most of all, to achieve a broader view and understanding of different cultures. This is especially true for science and medicine, where English is the common language and a basic requirement which 3

opens many doors". Elena Lora- Physiotherapist, Bologna My experience with Medical English by Pikku Vichert was extraordinary! We role played like in a doctor’s office, we did clinical histories, we learned technical language. I definitely improved my Medical English skills and it really helps me now in my Medical practice. So, I absolutely recommend the course and the learning material! Monica Almanza - Ophthalmologist, Mexico City I was troubled that I couldn’t think in English the same way as I could in my first language. With VMEI, I spoke a lot of English in natural situations and also read and listened. That allowed me to solve my problem. I think Pikku is a treasure in my life. Ikumi Yamamoto - Physiotherapist The program is suitable for those looking to learn in different ways in addition to the standard normal ones. It changes the idea of old boring classes." Ahmad M. Thuaimer - Intervential Radiology, Dammam, Saudi Arabia ...Student’s comments continued at end of book

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These books are intended for adults in the medical professions, doctors, nurses, medical students, pharmacists, medical technicians and other professions where medical terminology and usage is needed. They are meant for students who already know some English, and who really want to learn. Using the methods and unique curriculum developed by Pikku Vichert, these books concentrate on the use of English in a medical context. They teach both the language and culturally appropriate communication skills for practicing medical careers in an Englishspeaking environment. Pikku is a highly respected professional with a degree in medicine and over 20 years of ESL experience. She has researched all the standard methods of instruction and adapted them to her own philosophy of learning. She believes that students learn best if they are thoroughly engaged and actively enjoying the process. email her at [email protected]

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HOW TO USE THIS BOOK The best way to use these books is to have a partner(s) or someone you can work with. You can do it alone, but you will need some self-discipline to be successful. The bulk of the material is based on clinical histories, where the interaction is between doctor/patient, doctor/nurse, doctor/doctor, nurse/patient, nurse/nurse and pharmacist/client. After going over the vocabulary, the first step is to read the dialogue out loud and understand as much as possible. If it is done with someone else, then each person reads a few sentences. Then try to role play the dialogue. Doing it outside a classroom, read it again, a few times out loud - if you have a partner, role play it with the partner, taking turns being different characters. If it is done in a class, then the teacher should note down all the mistakes and give the student a chance to correct them before giving the students feedback and any remaining corrections. If you are alone, you will have to find the meanings of unknown words, and the mistakes yourself. (thank goodness for the internet!) 6

The listening materials and the role play materials are done in the same way, each with its own emphasis. The listening material, for example, concentrates on pronunciation. Pikku can help students who do not have partners, by having regular video calls with them or by arranging a partner for them. email her at: [email protected]

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Table of Contents DIALOGUES............................................................................................................... 9 1. COPD ....................................................................................................................9 2. ASTHMA ...............................................................................................................15 4. PRODUCTIVE COUGH ...............................................................................................28 5. WHAT TO DO ABOUT SNORING ..................................................................................34 ANSWERS..................................................................................................................41 ROLE PLAY .............................................................................................................. 49 ASSESSING THE THORAX AND LUNGS ...............................................................................49 NASAL CANNULA (NASAL PRONGS) .................................................................................52 OXYGEN DELIVERY WITH A VENTURI MASK ......................................................................53 PURSED LIP BREATHING ...............................................................................................57 DIAPHRAGMATIC BREATHING ........................................................................................59 PERFORMING TRACHEOSTOMY CARE ..............................................................................61 LISTENING .............................................................................................................. 64 1. ASTHMA ...............................................................................................................64 2. CROUP..................................................................................................................69 3. CYSTIC FIBROSIS (CF) ..............................................................................................73 4. EMPHYSEMA ..........................................................................................................75 5. PNEUMONIA ..........................................................................................................79 6. PNEUMOTHORAX ....................................................................................................83 7. PULMONARY EMBOLISM ..........................................................................................87 9. TUBERCULOSIS (TB) ................................................................................................93 10. ACUTE BRONCHITIS ...............................................................................................96 11. PNEUMONIA ........................................................................................................99 ANSWERS............................................................................................................... 104

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Dialogues 1. COPD Vocabulary for Barbara’s COPD Damage – injury/harm Tube – a hollow vessel or organ Obstruction - blockage Former – previous/earlier Irritants – things causing something to be more sensitive Pollution – contamination/dirt of water, soil, and air Contribute – help to cause/is an important factor in/add Floppy – loose and flexible Elasticity – able to return to its original shape Destroy – to put an end to something Inflammation – redness, swelling, tenderness, heat X-Ray with COPD and pain in a part of body Mucus – slippery secretion from mouth, nose, esophagus and/or other body cavities Tend (verb) – is likely to Clog - block 9

Blessing - a special favor Cure - remedy a way to make something healthy permanently Reverse – opposite in direction or position Progression – movement forward Prescribe – to order (by a doctor) Advanced age – old age Taken a toll – cause gradual damage over time At this late date – late Blessing in disguise – an unfortunate situation that results in something positive

Practice your vocabulary – Barbara’s Mom’s COPD You may have to change the words below (in the word bank) to make the sentences grammatically correct Word Bank: destroy, inflammation, former, tend, damage, mucus, obstruction, contribute, reverse, pollution 1.

Doctor Jackson’s _______ nurse made headlines in a newspaper, because she rescued a baby from a burning building. 10

2.

Bad air and constant smog _________ to lung disease.

3.

Susan’s arm was ____________ which was the reason she applied ice on it.

4.

The reason the man in the ER could not breathe was that he had an ____________ in his airways.

5.

Barbara had a bad cough which made her bring up a lot of green _____________.

6.

Michael’s father had worked in a glue factory for many years. The polluted air and fumes (strongly smelling gases) had ____________ his lungs permanently.

7.

At the late stages of COPD, people ___________ to have blue lips due to lack of sufficient (enough) oxygen.

8.

The spirometer was ____________ in the hospital fire.

9.

The drugs didn’t ___________ Barbara’s COPD but gave her some relief.

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10. Due to an increased number of industries in the Fraser Valley, air _____________ has become a major concern (worry).

Barbara’s Mom has COPD - Dialogue Barbara: Doctor, my mom has just been diagnosed with Chronic obstructive pulmonary disease (COPD). Can you explain to me what it is? Doctor: Certainly. It is a lung disease, in which the lungs are damaged, making it hard for a person to breathe. In COPD, the airways, the tubes that carry air in and out of your lungs are partly obstructed, making it difficult to get air in and out. B: I guess smoking all those years has taken a toll on her lungs.

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Dr: Yes, cigarette smoking is the most common cause of COPD. Most people with COPD are smokers or former smokers. Breathing in other kinds of lung irritants, like pollutants, dust, or chemicals, over a long period of time may also cause or contribute to COPD. In COPD, the airways, and air sacs lose their shape and become floppy. Less air gets in and less air goes out because: The airways and air sacs lose their elasticity (like an old rubber band). The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. Cells in the airways make more mucus than usual, which tends to clog the airways. B: But it’s strange that she would get it now; she is already quite elderly, she is 78. Dr: COPD develops slowly, and it may be many years before one notices symptoms like feeling short of breath, for example. Most of the time, COPD is diagnosed in middle-aged or older people. So, your mom’s diagnosis at this late date is sort of a blessing in disguise, because living with COPD is not easy. 13

B: From the reading I’ve done, I understand that there is no cure – am I correct? Dr: That’s right, there is no cure for COPD. The damage to your mom’s airways and lungs cannot be reversed, but there are things she can do to feel better and slow down the progression of the damage. Your mom’s doctor will likely prescribe some inhaled corticosteroids as well as a bronchodilator for her. These meds. widen the airways temporarily so that she can breathe easier. B: What about surgery? Dr: At her advanced age I would not recommend surgery. B: I see. Thank you, doctor.

Comprehension Questions 1. What causes COPD? 2. What happens in COPD? 3. If a person has COPD, why does he/she inhale and exhale less air? 14

4. Why would a person with COPD use bronchodilators? 5. Why did the doctor think that surgery was not an option in the patient’s case (choice)?

2. Asthma Vocabulary for Brad’s Asthma Chronic – long term Strenuous – requiring great effort and energy Wheeze - to breathe with a whistling sound Pulmonary – having to do with the lungs Verdict – decision, opinion Environmental – things around you Trigger - cause Image from Blausen Medical Communications Inflammation – swelling, pain, tenderness and heat (together) Sensitive – easily pained or annoyed 15

Tend - is likely to Irritate – causing irritation/causing something unpleasant Narrow – the opposite of wide Cure - to heal/make something well after being sick Manage - control Infrequent – not often/not regular Aggravate – make worse Epipen - a device that injects epinephrine intramuscularly in the treatment of anaphylactic shock Shot – (here it means) an injection Accurate - true/free from errors (mistakes) Immediate – quick/instant Not that I know of – I don´t think so/you say that when you think the answer is NO but can´t be sure Peak flow monitoring (PFM) – how air flows out from a person´s lungs in one ¨fast blast¨ Bring it on – causes

Practice your vocabulary – Brad’s Asthma You may have to change the words below (in the word bank) to make the sentences grammatically correct 16

Word Bank: trigger, wheeze, aggravate, irritate, strenuous, shot 1. Doctor Bento heard some _____________ sounds coming from his office. 2. Doctor Bento rushed to her aid and gave her a ______________ of corticosteroids. 3. Margaret found that the tape that kept the IV in place _____________ her skin. 4. Margaret told Dr. Bento that she thought that her _______________ exercise had brought on the attack. 5. Exercises that require great effort, would only ______________ her asthma. 6. Doctor Bento told Margaret that in the future she should try and avoid any such ________________.

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Brad’s Asthma - Dialogue Brad is 32 years old. He is physically active and is a hockey coach for the Vancouver minor league hockey school. Brad: Hi Doctor, I have been having this chronic cough for a really long time. My wife thought that I should have it looked after. Doctor: Let me ask – how long have you had it? B: Two to three months. In fact, I had a bad cold about two to three months ago, and it seems to me that I’ve been coughing ever since. I cough a lot at night, which makes my wife unhappy. I’ve also noticed lately that when I run and do any strenuous exercise, I start to cough and wheeze. Dr: Any family history of asthma? B: No, not that I know of. Dr: I’d like to send you to a lung function test. They will use a spirometer. It is the most common pulmonary function test. I’d also like you to have a chest x-ray, blood tests, allergy tests, and lastly peak flow monitoring (PFM). We’ll make another 18

appointment for you two weeks from now – by then the results should be in. Brad’s results are in B: So, what’s the verdict doctor? Dr: Well, based on your history and these tests, I would say that you have Asthma. B: I know my symptoms and the way I feel, but what causes them? Dr: The basic cause of the lung abnormality in asthma is not yet known. There may be many environmental factors that can trigger it. When you have asthma, the inside of your airways is inflamed. The inflammation (IN-fla-MAY-shun) makes the airways very sensitive, and they tend to react strongly to things that you are allergic to or find irritating. When this happens the airways get narrower, and less air flows through to your lungs. This causes symptoms like wheezing (a whistling sound when you breathe), coughing, chest tightness, and trouble breathing, especially at night as you mentioned earlier. B: How about the cure? Is there such a thing? 19

Dr: I’m afraid there is no cure for asthma, but it can normally be managed quite well. If you take care of yourself and control your asthma, you should have infrequent symptoms, and can lead an active and normal life. B: What kind of treatment is available? Dr: Naturally, you need to avoid things that bring it on. Another important thing is to take your medicine as prescribed. Learn to recognize the signs of aggravation and KNOW what to do when your asthma gets worse. I’ll prescribe a beta-2-agonist pump for you and we’ll monitor (check) your situation. I’ll also give you an epipen for emergencies; you can give yourself a shot. B: Thanks doctor.

Comprehension Questions 1. What does inflammation inside airways do? 2. What causes wheezing? 3. How can Asthma be cured? 4. How can serious symptoms be prevented? 20

5. How is Asthma treated? 6. What does strenuous exercise cause in people with asthma? 7. What is another way of saying ‘bring it on’?

Vocabulary for Peter’s TB (tuberculosis) Bother – to give trouble/annoy Describe – to give a detailed account in words about something Quite – really, truly Mucus - thick saliva Lymph glands – see picture Definitely – clearly, absolutely Swollen – enlarged Attack – seizure due to disease Properly - well Fatal- deadly/can kill Ailing – sickly/unwell Exposed – have contact with

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Contagious – infectious/spreads disease to another person Feeling under the weather – feeling unwell Pay you a visit – come to see you Bring up anything? – are you coughing up any phlegm or mucus

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3. Tuberculosis Practice your vocabulary – Peter’s TB You may have to change the words below (in the word bank) to make the sentences grammatically correct. Word Bank: bother, contagious, definite, expose, mucus, ailments, fatal, proper 1. Barbara’s mother didn’t let her go to school, because her cold was still ______________. 2. Steve was constantly visiting his doctor, because he had so many ______________. 3. Maggie was unable to close the pill container _______________ and asked her daughter to help her. 4. Truman’s condition was ______________ getting much worse, so he decided to pay a visit to his doctor. 5. Tamara worked at the TB ward and was constantly (all the time) ____________ to many diseases. 23

6. Bob was having a lot of problems with his _____________, so the nurse decided to suction it out. 7. Penny found out last night that her daughter had been in a _____________ accident. 8. The constant snoring _____________ Peter’s wife.

Peter visits his doctor - Dialogue Peter is a 69-year-old man who lives with his wife Ruth. Peter: Hi Doc. I’m feeling under the weather and thought I should pay you a visit. Dr: What’s bothering you Peter, can you describe to me how you feel? P: Well, a few weeks back, I started to have a lot of night sweats. Now my chest hurts, and I cough quite a bit. Dr: Bring up anything? 24

P: Yes, thick, cloudy, and sometimes bloody mucus. I’ve done some reading on the internet. Could it be lung cancer? Dr: Honestly, I can’t answer that until I’ve finished examining you. I’m also going to send you to the lab for some tests. Any other pains? P: My neck is kind of swollen. Dr: Yes, I see that – let me check- hm... yes, your lymph glands are definitely swollen. You seem tan, have you been traveling? P: Yes, I came back from India a month ago. I spent six months there. Dr: Were you in contact with people who were sick? P: I can’t really tell – possibly. Dr: I’d like you to have the Mantoux test, since you have been in India. They have their share of TB. I’m also going to send you for a chest x-ray. Ten days later Peter comes back to get his test results. Dr: Hello Peter. Your tests are back. 25

P: Is it lung cancer? Dr: No, not lung cancer, but you have developed TB. P: What causes TB? Dr: Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But TB bacteria can attack any part of the body such as the kidneys, spine, and brain. If not treated properly, TB can be fatal. P: OK, let’s get on with it. What’s involved? Dr: Because you have an active case of TB, I’m afraid that the treatment will take some time. You will take a cocktail of four drugs (1. Isoniazid, 2. Rifampicin, 3. Pyrazinamide and 4. Ethambutol) for two months, then after that you will take just two medicines (1+2) alone for a further four months. Normally we consider a patient cured at six months. P: What about Ruth? She wasn’t with me in India, because she had to stay home to take care of her ailing mother. She seems fine. Ruth was tested. She has the infection, but has not yet developed active TB 26

Dr: Ruth, because you have been exposed to the TB bacteria, we need to start you on some antibiotics in order to prevent it from developing to an active case. Peter, because your condition is highly contagious, I want you to wear a mask when you go out. Also, it is important that you wash your hands frequently, to prevent the spread of the bug (the bacteria). P: Thanks Harry, I’ll be back for check-ups. Bye for now. Dr: See you soon. Mantoux test – is a tuberculin test

Comprehension Questions 1. Why was it important for the doctor to know that Peter had been travelling in India? 2. Why do you think Peter thought that he had lung cancer? 3. What area does TB affect in the body? 4. Who is Harry? 27

4. Productive Cough Vocabulary for Tamara’s Productive Cough Persistent - constant Productive – pertaining to producing sputum or mucus Stuff – something (in this case, mucus) Sticky – something that sticks together Mucus – thick slippery sputum Drowsy – sleepy Phlegm – thick mucus Sputum – saliva (spit) mixed with mucus or pus Pus – a yellowish- white substance produced by infected tissue Suppress – to put a stop or an end to something Antitussive – medicine to relieve or stop coughing Reflex – involuntary movement Irritate – bother, annoy To nurse - here it means, to breastfeed Alternative - a choice limited to one, two, or more possibilities Compatible - able to exist together with something else 28

Hydrate – to drink water, to supply water to (a person, for example) in order to restore or maintain (keep) fluid balance Run its course – to progress along a natural course (here of a disease)

Practice your vocabulary – Tamara’s Productive Cough You may have to change the words below (in the word bank) to make the sentences grammatically correct Word Bank: persistent, suppress, sticky, phlegm, pus, alternative, drowsy, antitussive, hydrated, compatible 1.

Doctor Smith wanted to _____________ information regarding the accident in the OR.

2.

Nurse Tina and Doctor Mark were very _______________ together which is probably the reason they got married.

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3. 4.

Tom had so much _______________ in his airways that it was difficult for him to breathe. _________________ syrups are good for stopping coughing.

5.

Many people think that there are too many medication ________________ on the market.

6.

Brita had a big white pimple on her forehead that was full of _____________

7.

The medication was so ________________ that it was difficult to pour out of the bottle.

8.

Some medications make people very _______________ which is the reason they should be taken at night-time.

9.

The ___________________ ringing of the telephone made Dr. Lindy irritated.

10. Doctor May asked the nurse to hook Pam onto the IV in order to keep Pam ____________.

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Tamara’s Productive Cough - Dialogue Tamara visits her local pharmacy with her six-monthold baby girl. She wants to find out more about cough medicines and their safety. Tamara: Hi. I have this persistent cough that doesn’t want to go away. Could you show me some of your products that might work for me; there are so many to choose from? Pharmacist: Certainly. What’s your cough like? T: I’m not sure how I should answer that. Isn’t a cough a cough? P: There are basically two different types of coughs, one, which we call a productive cough, and the other is a non-productive one. T: I see – so in the one, stuff comes up when you cough and in the other type nothing is coughed up. P: That’s correct. Are you producing anything when you cough? T: Yes, I cough up sticky mucus. 31

P: We have a couple of choices; Tussi Organidin ® NR, Robitussin®, Benadryl, Guaiphenesin and Bromhexine. The first two are fine for daytime use and don’t make you drowsy, but Benadryl has an active ingredient called diphenhydramine in it which may cause drowsiness and is best taken at night- time. T: How does the medication for a productive and a non-productive cough differ? P: The medicine for a productive cough is called expectorant. It loosens the mucus (phlegm, sputum) in the airways so that it is easier to bring it up and out. This type of cough should never be suppressed because it clears the mucus from the lungs. Medications for dry cough or non-productive cough are treated with antitussives (antitussive suppressants). Cough suppressants block your cough reflex so that you don't cough as much when your throat is irritated. Most cough suppressants block the cough reflex in the part of the brain that regulates automatic cough. T: I’m still nursing my baby and was wondering which OTC drug is the safest? P: Guaiphenesin and Bromhexine are considered safe for breastfeeding moms, but we also carry some 32

herbal alternatives such as Simple Linctus, and Nin Jiom, Chinese cough syrups which are compatible with breastfeeding. T: That’s good. I think that I’ll give the Nin Jiom a try first, and if it doesn’t work, I’ll come back and get the Guaiphenesin. I wonder how long this will last; I’ve had it already for five days. P: A common cold will usually run its course within seven to 14 days. So, you should take the Nin Jiom three times a day. Drink a lot of water; it’s good to stay hydrated. T: Thanks

Comprehension Questions 1. What is Tamara’s reason for visiting the pharmacy? 2. What is meant by a productive cough? 3. Why should an antitussive medication not be used for a productive cough? 33

4. Why is it good to use an antitussive syrup for a dry cough? 5. Why is Tamara careful when choosing the best cough syrup for her? 6. What is meant by ‘run its course’?

5. What to do about Snoring Vocabulary for What to do about Snoring Annoy – to disturb or bother in a way that displeases a person Snore - to breathe during sleep with hoarse or harsh sounds caused by the vibrating of the soft palate. Get rid of – become free of something, eliminate Occur - happen Partially - partly, not completely Narrow – opposite of wide Instance - case Tends – is likely to Frequently - often Episode – happening, event Accompany – come along, associate with Sleep apnea – stoppage of breathing temporarily during sleep 34

Extreme – very/much more than normal Fatigue – extreme tiredness Interfere - hinder, prevent, intervene Vehicle – here it means a car Alternative – one of many possible choices, choice Approach - method Avoid - to keep away from; keep clear of Induced – something is produced or caused by using chemicals (in this case sleeping pills cause a person to fall asleep) Sedatives - medication that calms a person Pause – stop temporarily Deprive – to take something away from someone or something Tummy – abdomen/´stomach´ Measures - methods Alleviate – to make less, lessen Run in some families – is present in some families Look into – check out Stands for - means

Practice your vocabulary – What to do about Snoring You may have to change the words below (in the word bank) to make the sentences grammatically correct 35

Word Bank: avoid, induce, approach, deprive, tummy, eliminate, alternative, interfere 1. Doctor Breatheasy’s __________ to treatment is fairly traditional. 2. In sleep apnea, there are many ______________ to treatment. 3. The cast in Robert’s arm ______________ with his daily activities. 4. Lisa’s children were _______________ of food and education, because their mother was very poor. 5. The CPAP machine _______________ the need for surgery. 6. Marcus had a _____________ ache and didn’t want to go to school. 7. Pam should _______________ taking alcohol and sleeping pills together. 8. Doctor Palmer ______________ Tamara’s labor (childbirth), because she had been pushing for 20 hours already. 36

What to do about Snoring - Dialogue Harry: Doctor, my wife is getting annoyed with me, because she says that I snore all night long, and she says that she doesn’t get any sleep. She would like me to have some sort of an operation or something to get rid of the snoring. What’s the reason for snoring? Don’t women snore? Doctor Breatheasy: Snoring occurs in all age groups and both sexes but is more common in men. Being overweight and having a thick neck are the most common causes. H: I think that my dad was also a snorer. Dr: This condition seems to run in some families, suggesting a possible genetic basis (cause). H: What causes snoring? Dr: Snoring means that the airway is partially narrowed which makes a grunting sound in the person´s breathing. But what happens in some instances is that the airway closes completely. The upper airway closes completely and therefore you stop breathing. The medical term for this is sleep apnea. The stopping of breathing can last for 10, 20, 37

30 or 40 seconds and after that there is a short explosion of air coming out of the lungs and the individual (person) tends to wake up. H: Yes, I seem to wake up frequently. D Now, these episodes of snoring accompanied by sleep apnea can happen many times at night. It can happen over 100 times a night. H: So that explains why I’m extremely fatigued some mornings and don’t feel like getting up. Dr: Yes, fatigue is the most common symptom. Most sufferers also feel extreme daytime sleepiness which then interferes with other activities. Driving a vehicle also becomes very dangerous. H: What are some of the treatment alternatives? Dr: My approach would be for you to lose a bit of weight. And if you smoke, it’s best to stop. Also, night-time use of alcohol should be avoided. 38

H: Is one beer too much? Dr: In my opinion no alcohol at night will be best. H: Well, I usually have a drink or two just to relax, so that I can sleep better. Dr: Just the opposite. Any relaxation induced by alcohol or sedatives such as sleeping pills should be avoided because they can increase the pauses between breaths and deprive your brain of oxygen. I would also recommend that you sleep on your side or on your tummy. Often with these simple measures you can do a great deal to alleviate your symptoms. H: So, if these things don’t work, what then? Dr: Then I would look into a machine called CPAP. It stands for continuous positive air pressure. H: What about surgery? Dr: I would recommend conservative treatment first. If it doesn’t work, then we can talk about surgery. 39

H: Thanks, I’ll go home and try a new diet and no alcohol at nights. Dr: I’ll see you in a month or so. Bye for now.

Comprehension Questions 1. Why did Harry visit his doctor? 2. How common is snoring? 3. What causes snoring? 4. What are symptoms of sleep apnea? 5. Why should Harry not use sleeping pills? 6. What do you think is the best treatment for sleep apnea?

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Answers 1. Practice your vocabulary – Barbara’s mom’s COPD You may have to change the words below (in the word bank) to make the sentences grammatically correct Word Bank: pollution, destroy, inflammation, former, tend, damage, mucus, obstruction, contribute, reverse 1. Doctor Jackson’s former nurse made headlines in a newspaper, because she rescued a baby from a burning building. 2. Bad air and constant smog contribute to lung disease. 3. Susan’s arm was inflamed which was the reason she applied ice on it. 4. The reason the man in the ER could not breathe was that he had an obstruction in his airways.

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5. Barbara had a bad cough which made her bring up a lot of green mucus. 6. Michael’s father had worked in a glue factory for many years. The polluted air and fumes (strongly smelling gases) had damaged his lungs permanently. 7. At the late stages of COPD, people tend to have blue lips due to lack of sufficient (enough) oxygen. 8. The spirometer was destroyed in the hospital fire. 9. The drugs didn’t reverse Barbara’s COPD but gave her some relief. 10. Due to an increased number of industries in the Fraser Valley, air pollution has become a major concern (worry).

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Answers 2. Practice your vocabulary – Brad’s asthma You may have to change the words below (in the word bank) to make the sentences grammatically correct Word Bank: trigger, wheeze, aggravate, irritate, strenuous, shot 1. Doctor Bento heard some wheezing sounds coming from his office. 2. Doctor Bento rushed to her aid and gave her a shot of corticosteroids. 3. Margaret found that the tape that kept the IV in place irritated her skin. 4. Margaret told Dr. Bento that she thought that her strenuous exercise had brought on the attack. 5. Exercises that require great effort, would only aggravate her asthma.

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6. Doctor Bento told Margaret that in the future she should try and avoid any such triggers.

Answers 3. Practice your vocabulary – Peter’s TB You may have to change the words below (in the word bank) to make the sentences grammatically correct. Word Bank: bother, contagious, definite, expose, mucus, ailments, fatal, proper 1. Barbara’s mother didn’t let her go to school, because her cold was still contagious. 2. Steve was constantly visiting his doctor, because he had so many ailments. 3. Maggie was unable to close the pill container properly and asked her daughter to help her. 4. Truman’s condition was definitely getting much worse, so he decided to pay a visit to his doctor.

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5. Tamara’s worked at the TB ward and was constantly (all the time) exposed to many diseases. 6. Bob was having a lot of problems with his mucus, so the nurse decided to suction it out. 7. Penny found out last night that her daughter had been in a fatal accident. 8. The constant snoring bothered Peter´s wife.

Answers 4. Practice your vocabulary – Tamara’s Productive Cough You may have to change the words below (in the word bank) to make the sentences grammatically correct Word Bank: persistent, suppress, sticky, phlegm, pus, alternative, drowsy, antitussive, hydrated, compatible 1.

Doctor Smith wanted to suppress information regarding the accident in the OR. 45

2.

Nurse Tina and Doctor Mark were very compatible together which is probably the reason they got married.

3.

Tom had so much phlegm in his airways that it was difficult for him to breathe.

4.

Antitussive syrups are good for stopping coughing.

5.

Many people think that there are too many medication alternatives on the market.

6.

Brita had a big white pimple on her forehead that was full of pus.

7.

The medication was so sticky that it was difficult to pour out of the bottle.

8.

Some medications make people very drowsy which is the reason they should be taken at night-time.

9.

The persistent ringing of the telephone made Dr. Lindy irritated.

10. Doctor May asked the nurse to hook Pam onto the IV in order to keep Pam hydrated. 46

Answers 5. Practice your vocabulary – What to do about Snoring? You may have to change the words below (in the word bank) to make the sentences grammatically correct Word Bank: avoid, induce, approach, deprive, tummy, eliminate, alternative, interfere 1. Doctor Breatheasy’s approach to treatment is fairly traditional. 2. In sleep apnea, there are many alternatives to treatment. 3. The cast in Robert’s arm interferes with his daily activities. 4. Lisa’s children were deprived of food and education, because their mother was very poor. 5. The CPAP machine eliminates the need for surgery.

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6. Marcus had a tummy ache and didn’t want to go to school. 7. Pam should avoid taking alcohol and sleeping pills together. 8. Doctor Palmer induced Tamara’s labor (childbirth), because she had been pushing for 20 hours already.

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Role Play Assessing the thorax and lungs Nurse: Hi Mrs. Miller. I’m Susie your nurse. The doctor asked me to assess your chest and back as well as your lungs. I’ll just have a look at your wrist band - to make sure. Good- let’s get started. Mrs. Miller: Please call me Mary. Nurse: I understand you’ve been having trouble breathing, I hope it gets easier. Mary: I’ve been a smoker for the past 30 years-I guess it has taken a toll on my health, in particular my lungs. I’ve tried to stop, but my addiction is so strong. Nurse: It’s great to hear that you are tackling the issue. It is very difficult. I take my hat off to you. Mary: Should I be sitting? Nurse: That would be great - if you could but let me know if it is at all difficult and I’ll elevate the head of your bed (between 45-90 degrees). I’ll just put the 49

bedrails (side rails) down - there. I’ll wash my hands, so they are clean and warm. I think we’re ready Mary. I’ll start from the back. I’ll just open the gown - let me know if you feel cold. Just breath through your mouth normally Mary: OK. Nurse: I’ll explain everything as we proceed. If you want to ask me something at any time - feel free to interrupt me. I’m going to palpate your back first and then I’m going to listen. Mary: Should I be doing deep breathing? Nurse: I’ll let you know Mary: I understand. Nurse: Take a deep breath now and breath through your mouth. Good - one more – there. Now raise your arms. I’ll just have a listen here - good. Is it difficult for you to take deep breaths? Mary: Yes, I feel pain in some places. Nurse: We are all done. I’ll just put the head of the bed back down and raise the bedrails. Are you getting on OK otherwise? 50

Mary: Yes, I’m comfortable. I’m waiting to have some tests. Nurse: I’ll look in on you later - bye for now.

VOCABULARY - Assessing the thorax and lungs assess: to check, examine thorax: the part of the human body between the neck and the diaphragm I’ll just have a look at your wrist band: the nurse makes sure it is the correct patient (that she hasn´t made a mistake) has taken a toll: has caused damage gradually over time addiction: dependence tackling the issue: trying to do something about it, trying to resolve it I take my hat off to you: I congratulate you elevate: bring up bedrails: the sides of a hospital bed to prevent a patient from falling gown: a long loose garment (clothing) worn in the hospital by the patients proceed: go on interrupt: stop 51

palpate: examine by touching with the palms of the hand and fingers getting on: managing look in on you: check how you are doing

Nasal cannula (nasal prongs) Instructing patients (create your own role play) 1. Hi Mr/Mrs _________________. Your doctor has ordered some oxygen for you. 2. These are nasal prongs and an oxygen mask (Shows the patient) They will help you get oxygen. 3. I’m going to place (put) these prongs into your nostrils now – there. 4. And now I’ll just slip the elastic (rubber) band around your head to keep it in place. 5. Now I’ll just adjust the tubing around your ears – there we go.

Nasal prongs

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6. Now I need to use this plastic holder to keep it all in place. Excellent! 7. I’m all done. How does it feel?

VOCABULARY nasal prongs: nasal canula/see picture nostrils: the two holes at the end of the nose used for breathing to slip: here it means to slide the rubber band into place I´ll just adjust: we use the word “just” to make it all seem uncomplicated in order to relax the patient. It adds no extra meaning There we go: that´s it/all done

Oxygen Delivery with a Venturi Mask Nurse to Nurse - Shift Report Nurse 1: Good morning ___________. How was your night? Nurse 2: Quite hectic, actually. 53

N 1: I see we have a new admission. N 2: We have a new patient in bed 6, Lily Jones. She’s an 84-year-old woman with a history of COPD and is on home oxygen, 1-2 liters per minute (L/min.) She presented with cough, chills, and SOB. On physical examination she was afebrile and tachypneic and her O2 sats were 94% on 2 liters of oxygen. Her pulmonary exam was unremarkable, and the chest xray revealed bilateral lower lobe infiltrates. N 1: Pneumonia? N 2: That’s right. Community acquired pneumonia and COPD exacerbation. N 1: Is she using a Venturi mask? N 2: Yes. She’s getting O2, 28% via Venturi mask with a flow rate of 4 liters. Her target saturation level is between 88-94%. When the Saturation rises above 92%, she needs to be switched to 24% Venturi mask. Keep a close eye on her levels. OK? When she’s stable, we can switch her over to a nasal cannula. N 1: Yes. Any bloodwork for today?

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N 2: The doctor ordered an ABG, and a sputum culture. N 1: No problem. Is she able to take anything by mouth? N 2: She’s on IV fluids for dehydration and can have a soft diet as tolerated. Can you encourage her to eat? N 1: Sure. Hopefully she will be stable enough for discharge in a few days.

VOCABULARY - Oxygen Delivery hectic: busy, chaotic actually: really, truly COPD: chronic obstructive pulmonary disease home oxygen: O2 therapy at home presented: exhibited chills: shivers SOB: shortness of breath afebrile: without fever tachypneic: rapid respirations sats: short for saturation unremarkable: nothing unusual

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revealed: showed bilateral: having two sides lobe: part of the lung infiltrates: body fluids that have passed into a tissue or body cavity pneumonia: lung infection community acquired pneumonia: (CAP) is a disease in which individuals who have not recently been hospitalized develop an infection of the Venturi mask lungs Courtesy of Mosby's Medical exacerbation: making a Dictionary, 9th edition. © 2009, bad situation worse Elsevier. Venturi mask: a disposable face mask that delivers a controlled oxygen concentration to a patient target: goal saturation: the amount of oxygen bound to hemoglobin in the blood stable: something that will not change easily/resistant to change switch: change bloodwork: lab tests for blood 56

ABG: arterial blood gas sputum: spit, saliva IV: intravenous dehydration: loss of water and salts important for normal body function tolerate: stand/put up with encourage: to give emotional support/to inspire with hope discharge: here it means to go home from the hospital keep a close eye on her: monitor/watch her/observe her regularly take anything by mouth: to eat

Pursed Lip Breathing Instructions for An ALS Patient The nurse will give breathing instructions to an ALS patient suffering from dyspnea (shortness of breath/difficult or labored breathing) You can create the patient responses(answers) 1. Hi _________________. I’m going to teach you how to do pursed lip breathing. It should help you breathe easier. You can sit up. Here, let me bring the head of your bed up. There, is that comfortable for you? 57

2. First, I’d like you to inhale s l o w l y through your nose while counting to yourself ‘one one hundred’, two one hundred’, ‘three one hundred’. Try to do it slowly, there is no rush. - Good. 3. Now purse your lips and blow out (exhale) slowly and evenly for about six seconds. The sound made will be like a small, soft whistle. (patient follows the instructions) That’s right. 4. Let’s do it again. 5. You can do eight to ten repetitions, three to four times/day. (If the patient is unable to sit, it can be done in lying or standing position) Pursed lips

VOCABULARY - Pursed Lip Breathing Pursed lips: see picture rush: hurry 58

exhale: breathe out whistle: to produce clear musical sound by forcing air through teeth or pursed lips

Diaphragmatic Breathing For A COPD Patient (create your own role play based on the information given) Hi _________________. Today I’m going to show how to do diaphragmatic breathing. It should help slow down your breathing rate. It will also decrease your oxygen demand. Ok, let’s get started. Lie on your back (on a flat surface or in bed), with your knees bent and your head supported. That’s good. You can use a pillow under your knees to support your legs and lower back. There. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.

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Breathe in slowly through your nose (so that your stomach moves out against your hand). The hand on your chest should not move. Hold your breath for a count of three. Now, tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain (stay) as still as possible. Practice this exercise for five minutes, three to four times per day. This exercise can be done while sitting.

VOCABULARY Diaphragmatic Breathing COPD: chronic obstructive pulmonary disease diaphragm: the bell-shaped muscle involved in breathing demand: here it means: ´your body asks for´/requires there: here it means like that/like so

Rib cage

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rib cage: see picture for a count of three: while slowly counting to three in your mind exhale: breathe out pursed lip breathing: a breathing technique in which a person inhales slowly through his nose and then breathes out through pursed lips (lips that are puckered like ready for whistling)

Performing Tracheostomy Care Suctioning 1.Hi Mr/Mrs. __________________ it’s time to suction your (endo) tracheal tube. It’s not the most pleasant of things, but it’s necessary You can cough in between the two suctionings. I’ll rinse the catheter and when I´m doing it, it´s a good time for you to try and clear your throat and cough. I’ll also put the trach mask over your face so that you can breathe humidified oxygen while I rinse the catheter - OK.

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If at any time you feel that you can’t breathe or that something is wrong, give me a signal by lifting your hand. 2. OK, I’m putting the catheter in now. 3. There, you can try and clear your throat and cough now. Is everything all right? OK. 4. I hear some more gurgling. I think we need to do it one more time – there, all done.

Trach mask

VOCABULARY - Performing Tracheostomy Care suction: to use a tube to remove phlegm (a thick substance in your throat) rinse: wash with water 62

catheter: a thin tube used to remove mucus and phlegm (in this case) trach mask: tracheostomy mask used in this case to deliver humidified oxygen to the patient clear your throat: to give a small cough to remove anything that makes speaking or breathing difficult gurgling: a broken and irregular noise made when breathing

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Listening 1. Asthma Fourteen-year-old Stella Engels is experiencing difficulty breathing during exercise. She’s visiting a new doctor with her mother to discuss the problem. Doctor: Nice to meet you, Stella. I’m Doctor Thom. Stella: (Shyly) Hi. Dr.: So, I understand you’ve been having trouble when you exercise. Can you tell me about that? S: Well, it’s no big deal (it´s really not all that bad). Dr.: Why don’t you let me decide that? S: Well…I just get tired when I do gym, like when they make us run around. Dr.: What else besides getting tired? S: Oh, sometimes I cough a lot, like about after a minute of running. Then I have to stop. 64

Dr.: Do you wheeze when you cough? S: Um, yeah. Dr.: Trouble breathing? S: Sometimes, yeah. Dr.: Stella, have you ever had this condition before? S: Um, no. This is the first time. Maybe I’m just out of shape. Dr.: I think it’s more than that. Do you have any allergies? S: No. Dr.: What about eczema? S: When I was much younger Dr.: Right. Well, Stella, Mrs. Engels, it’s possible that we’re looking at asthma here. It’s not severe by the sounds of it, and I won’t know until we try you on medication and see if it helps. If it does, then we’ll know for sure that the diagnosis is correct. I’d like to add that asthma and eczema often go hand in hand 65

(are closely related), even though Stella no longer has eczema. Mrs. Engels: So, we’ll try the medication - and if it doesn’t confirm your hunch? Dr.: Then we’ll have to try to get to the bottom of this Puffer with more tests and a thorough examination. In the meantime, I’m going to prescribe a puffer with Albuterol. Stella you’ll have to carry it with you during gym class and any other time you exercise. If you feel that you’re having trouble breathing, then you take a little rest and use your puffer. If you feel better, you can carry on. But don’t overdo it. S: How do I use a puffer? Dr.: The pharmacist will show you all about it. Now I’d like to see you again in two weeks to find out how it’s working. Mrs. Engels you can make the appointment with the nurse on the way out. Mrs. Engels: I don’t know, we’re awfully busy, my husband and I. 66

Dr.: It’s crucial that we follow up on this. You’ll have to try to make time. Mrs. Engels: We’ll see.

ASTHMA Match the numbers with the letters 1. 2. 3. 4.

wheeze out of shape eczema asthma

5.

by the sounds of it confirm

6. 7. 8.

a. sounds/looks/appears to be b. verify/prove c. very important d. to breathe with difficulty and with a whistling sound e. do too much f. often allergic disorder of respiration g. not physically fit

hunch get to the bottom of this h. to discover the truth about something/find the cause. 9. thorough i. doctor orders treatment 10. meantime j. an inflammatory condition of the skin 11. prescribe k. complete/detailed 67

12. carry on 13. overdo 14. on the way out 15. crucial

l. the time between one occurrence and another; an interval/meanwhile m. when you leave n. educated guess o. continue

Comprehension Questions 1. What is the purpose of Stella’s visit? 2. Describe her symptoms in detail. 3. What questions did the doctor ask? 4. What was his diagnosis? 5. How will he test to see if his diagnosis is correct? 6. What did he prescribe for this patient? 7. Why might it be difficult for Stella to come back in two weeks? 8. How would you have convinced the mother to come back, had you been the doctor? 68

9. Discuss what you know about asthma.

2. Croup Dorian Gray has brought his son Oscar into the ER because of worsening flu symptoms. ER Paediatrician: Hello, I’m Doctor Ross. I’m a paediatrician here at the ER. You’re the dad? Dorian: That’s right. I brought him in because he seems to be having trouble breathing. ER Paediatrician: Right. I’m going to have a look in his throat to make sure there’s no obstruction, just in case. Can you hold him still? D: I’ll try. ER Paediatrician: No obstruction there; that’s good. Now I’ll listen to his lungs. What’s his name? D: Oscar. ER Paediatrician: All right, Oscar, almost done. Good boy... He seems pretty hot. Has he been sick? D: He’s had the flu for about a week. But now his fever is worse, and he’s coughing really hard. 69

ER Paediatrician: Can you describe the cough? D: Well, it sounds like a, well, like a seal.

Seal

ER Paediatrician: Aha. Have you noticed a whistling sound when he breathes? D: Yes, when he’s calm, which isn’t very often…Well? ER Paediatrician: Mr. Gray, he’s showing classic signs of croup. It appears to be a moderate to almost severe case, so I’d like to keep him in overnight for observation. He may need a nebulizer to ensure that the airway is kept open. D: That sounds serious. ER Paediatrician: Don’t worry too much; it’s just a precaution. Better safe than sorry.

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CROUP Match the numbers with the letters 1. 2.

pediatrician still

3.

classic sign

4. 5.

croup appears

6.

moderate

7. 8.

observation nebulizer

9. ensure 10. precaution 11. better safe than sorry

a. seems b. a respiratory condition in which the person has hoarse (rough) cough and difficulty breathing d. doctor who specializes in children’s care e. not moving f. a spray used by people who have breathing trouble g. not extreme/within reasonable limits h. make sure i. an action taken in advance to protect against possible danger j. monitoring and noticing k. it is better to act carefully beforehand than to suffer afterward. l. typical sign

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Comprehension Questions 1. Where does this conversation take place? 2. Why did the father bring his son to the ER? 3. How old do you think the son might be? 4. Describe in detail the son’s current symptoms. 5. What challenge does the doctor face in diagnosing this patient? 6. Why do you think the doctor said “Aha!” when the father described his son’s cough? 7. What will the doctor do for this patient now? 8. Why is it important to observe this patient? 9. Discuss what you know about this condition.

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3. Cystic Fibrosis (CF) Al Ashkenazy is concerned about his infant’s chronic lung infections. NICU doctor: Mr. Ashkenazy, this is Victor’s third lung infection in a month. Even though he’s a preemie, his lungs should be more resistant by now. Al: Well maybe it’s the hospital environment. NICU doctor: Remember he’s been in an incubator all this time; his environment is quite sterile. I’d like to do some tests to see about other causes. Al: What are you thinking about? NICU doctor: In the worst-case scenario, it could be CF (cystic fibrosis). Al: Oh, dear. NICU doctor: There could be other conditions as well. I want to do a thorough series of tests. Al: If it is CF, he won’t live very long, will he?

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NICU doctor: There’s constant research into the condition, but right now, there is no cure. But let’s wait for the test results.

CYSTIC FIBROSIS - (CF) Match the numbers with the letters 1. concern 2. infant 3. chronic 4. preemie 5. resistant 6. environment 7. incubator 8. sterile 9. worst case scenario 10. thorough

a. our surroundings b. a baby before he/she can walk c. to fight against/defend d. the worst thing that could possibly happen e. without germs and bacteria/very clean f. long term/long lasting g. complete/detailed h. worry i. a baby born too early/premature j. an enclosed apparatus in which prematurely born infants are kept in controlled conditions, (such as temperature), for protection and care

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Comprehension Questions 1. Where is this conversation taking place? 2. What do you know about this infant? Give all the details. 3. What makes the doctor suspect a more serious condition? 4. Why is the father concerned when the doctor mentions the possibility of CF? 5. What is the prognosis for CF? 6. What do you think about the doctor’s bedside manner (behaviour and attitude with patients?

4. Emphysema Robert Darnley, age 64, is concerned about his heart. He is consulting his GP (family doctor). Doctor: Good morning Robert. Haven’t seen you in a while. 75

Robert: No, I haven’t been out much since Mary died. Dr.: I understand. How have you been keeping? R: Well, that’s what I’m here about. I’ve been feeling rather poorly. Dr.: Tell me about that. R: Well, I’m worried I might be getting heart trouble. Maybe angina. Dr.: What makes you say that? R: I get all out of puff, like when I go upstairs or carry anything heavy. Then I have to puff like crazy to get my breath back. And I get some pain in my chest. Dr.: Have you noticed any bluish colour on your lips when this happens? R: No, I get a bit reddish, actually. Dr.: Robert, the last time I saw you was a year ago, and I asked you to quit smoking. Have you done that? 76

R: I couldn’t. After Mary passed (died), I needed something to help get me through, you know. Dr.: Because I’m concerned that all these years of heavy smoking have taken their toll, I’d like to get you checked out, but I think we could be looking at emphysema. R: That’s not good, is it? Dr.: It certainly isn’t. It’s a degenerative condition and there’s no known cure. Right now, you absolutely MUST quit smoking. I’ll examine you today, then I’m going to have you admitted for tests at the hospital to rule out other conditions and to check for emphysema. R: Right. I see.

EMPHYSEMA Match the numbers with the letters 1. 2.

How have you been keeping? a. not feeling well at all feeling rather poorly b. to have a bad effect on someone or something 77

3.

angina

4.

out of puff

5.

get me through

6.

taken a toll

7. 8.

emphysema degenerative

9.

admit (to hospital)

10. rule out

c. eliminate (remove) from consideration d. a respiratory disease where the air sacs rupture e. short of breath/can´t breathe easily f. How have you been feeling? g. help me cope or manage h. check a person into a hospital for tests /treatment i. getting worse little by little j. chest pain

Comprehension Questions 1. Where is this scenario taking place? 2. How well do the doctor and patient know each other? Explain. 3. Describe the patient’s symptoms in detail. 78

4. Why does the patient think he could have heart trouble? 5. Why does the doctor ask about blue lips? 6. What condition does the doctor suspect? 7. How will the doctor diagnose this condition? 8. Why does the doctor insist that Robert quit smoking immediately? 9. What other conditions could this patient have? Justify your opinion. 10. Discuss what you know about emphysema.

5. Pneumonia Lisa has recently had a viral upper respiratory infection. She is not getting better and decides to visit her GP (family doctor). Doctor: Hello Lisa. What can I do for you today?

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Lisa: I’ve had this flu for a while now, but it doesn’t seem to be getting any better. Could it have developed into something serious? Dr: Let’s have a look. You’ve had your flu about four to five days, am I right? L: Yeah. I had a pretty high fever,39 degrees Celsius, chills, and aches& pains. Frankly, I thought I would be better by now. Since yesterday, I seem to have shortness of breath as well. I’m also bringing up some greenish phlegm. Dr: Any chest pain or sweating? L: Yeah, slight pain. I’ve been sweating since the onset of my flu. Dr: Let’s have a listen to your chest. Take a deep breath, exhale, another deep breath in, there. Hmm, I hear some abnormal bubbling or crackling sounds we call rales. I also hear some rumblings (rhonchi), which signal the presence of thick liquid in your lungs; that explains the greenish mucus that you are coughing up. L: Oh, sounds serious. What is it? 80

Dr: I think you have developed bacterial pneumonia as the result of your flu. You have all the classic symptoms, but to be a 100 % sure that we are dealing with pneumonia, I suggest that you have an X- ray and a blood test to check your white blood cell count. L: What’s the treatment for this? Dr: I’ll give you a prescription for 500 mg oral Erythromycin. Take it four times a day. You may start to feel better after beginning your medication but be sure to complete your entire course of antibiotics. Stopping the medication too soon may cause your pneumonia to return. It also helps create strains of bacteria that are resistant to antibiotics. Come back in 10 days and we’ll see how well you are doing.

PNEUMONIA Match the numbers with the letters 1 frankly

a. thick sputum

2. greenish

b. to make slight, sudden sharp noises, rapidly repeated (like frying something) c. you have 81

3. phlegm

4. onset 5. exhale 6. crackling 7. rales

d. green-like color e. all of the antibiotics f. start/beginning g. an abnormal respiratory sound characterized by fine crackles h. lung inflammation i. fight against j. honestly k. thick mucus

8. rumblings 9. mucus 10.pneumonia 11. we are dealing with 12. entire course l. breath out of antibiotics 13. resistant m. course rattling sound a little bit like snoring, usually caused by secretions in the bronchial airways

Comprehension Questions 1. Why is Lisa visiting her GP? 2. What are Lisa’s new symptoms? 3. What sounds does the doctor hear? 82

4. What does thick liquid in Lisa’s lungs indicate(mean)? 5. What is Lisa’s diagnosis? 6. What’s the treatment for her condition? 7. Why should she not quit taking her medication when she starts feeling better?

6. Pneumothorax An ICU (intensive care unit) nurse and her assistant are checking on a heart patient who was recently taken off a mechanical ventilator. Nurse: Mr. Stewart, how are you feeling today? Patient: A lot better since I’m off that vent. N: Yes, you must be more comfortable now. P: (begins to struggle for breath) Nurse… N: Mr. Stewart, are you having trouble breathing? (Patient nods and clutches his chest.) 83

N: Does your chest hurt? (patient nods) Can you show me where? (patient indicates location of pain) So it’s on your right-side. Don’t worry, Mr. Stewart. I’m going to get the doctor. (to assistant) Get me doctor Cruise, please, and quickly. (Doctor arrives) Doctor: What’s happening? N: He’s just developed shortness of breath and pain in his chest under his right shoulder blade and on the front. He’s hypoxic as well. He was just taken off the vent this morning; I suspect pneumothorax. Dr.: (listens to patient’s chest): It certainly sounds like it. We’ll get him to X-ray to see exactly what we’re dealing with. N: Are you sure we have the time, Doctor? Dr.: You to accompany him to X-ray, and if he goes downhill fast, page me. I’ll have a chest tube kit on hand, just in case. N: Right you are, Doctor.

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PNEUMOTHORAX Match the numbers with the letters 1. 2. 3. 4. 5.

mechanical ventilator vent struggle clutch indicate

6. 7.

shoulder blade hypoxic

8. pneumothorax 9. certainly 10. we´re dealing with 11. accompany 12. goes downhill 13. on hand

a. show b. c. d. e.

lack of oxygen fight really/surely/indeed a respirator/a machine that helps a person breathe f. to hold tightly or firmly g. you have/the diagnosis is/what we are working with h. (short for) ventilator i. gets worse j. the presence of air or gas in the pleural cavity k. available l. the scapula m. go together with someone

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Comprehension Questions 1. Where is this situation taking place? 2. What is the background on this patient? Give as much detail as you can. 3. How old do you suppose this patient is? Justify your answer. 4. What are the patient’s symptoms? Give full details. 5. What does the nurse believe to be the cause of this new condition? 6. Do you think the nurse acted appropriately in this situation? 7. What about the doctor’s actions? 8. Why does the doctor believe the patient’s condition is not severe? 9. Discuss what you know about pneumothorax.

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7. Pulmonary Embolism Andrea Rickard is recovering from surgery for a broken femur. Her nurse is checking on her. Nurse: Andrea, have you been up yet today? Andrea: Well… N: I’ll take that as a “no”. A: It’s too hard. I’m tired and my leg hurts. N: You’ve got to move around, even if it’s just to go to the washroom. If not, you risk thrombosis, even an embolism. A: What? N: Thrombosis is a blood clot in the veins; it’s quite common after surgery because patients remain immobile. If it breaks off and travels to the lung, it can be dangerous. A: Now you’re scaring me. N: You should take this seriously. You’re especially at risk because you’re overweight. Besides, now come on; I’m going to help you walk around a bit on 87

(or with) your crutches. Keep your weight on your good leg. Here we go. A: All right, all right.

PULMONARY EMBOLISM Match the numbers with the letters 1. I’ll take that as a “no”. 2. move around 3. thrombosis 4. embolism 5. remain immobile 6. crutches 7. good

a. move about, move b. unaffected/not affected c. a clot in a blood vessel d. support used for walking e. I guess the answer is NO. f. stay motionless, not moving g. obstruction or occlusion of a blood vessel by a mass, such as an air bubble, a detached blood clot, etc.

Comprehension Questions 1. Where is this conversation taking place? 88

2. What is the patient’s condition? 3. Has the patient been taking proper care of herself after the operation? Explain. 4. Why is this patient particularly at risk for thrombosis or pulmonary embolism? 5. Do you think the nurse handled the situation well? What would you have done, had you been the nurse? 6. Discuss what you know about pulmonary embolism (PE)?

8. Sleep Apnea Anne Bollin has brought her eight-year-old daughter Elizabeth to the doctor because of changes in behaviour. Doctor: Good morning Anne. Hello Elizabeth. Which one of you are we seeing today? Anne: It’s Elizabeth, actually. She’s acting a bit differently these days. 89

Dr.: How so? A: Well, normally she’s so easy-going, you know, but lately she’s been hyper and cranky. It’s like she’s over-tired. Dr.: That is unusual for her. Have there been any changes in her routine, lately? A: No, she goes to bed at the same time as usual. Only I’ve noticed that she’s been snoring more. And I hear her gasping a bit. Dr.: I see. It’s possible she´s developed sleep apnea. A: I thought that was something that obese people get. Dr.: Well there are different types and causes of sleep apnoea. Down’s children like Elizabeth are particularly at risk because of their facial structure. It can cause a kind of partial obstruction of the airway. A: I hope you’re not suggesting surgery to correct this. Dr.: No, that would be the last resort. The least intrusive option is a sort of mouth guard that she can 90

wear at night to keep the jaw in such a position that the airway can remain unobstructed. There’s also a sort of oxygen mask that she can wear, but she may object to that. A: Yes, I think we’d have better luck with the mouth guard. Dr.: Right. Well first of all, we’ll need to get a firm diagnosis. She’ll have to spend a night in hospital where we can monitor (observe, pay close attention to) her sleep. A: All right. She’ll like that; the nurses always spoil her. Dr: I’ll have my receptionist set up the admission and we’ll call you with the date. Note: spelling is either apnea or apnoea

SLEEP APNEA Match the numbers with the letters 1. 2.

hyper cranky

a. protection b. not blocked 91

3. 4.

snoring gasping

5. 6. 7. 8. 9. 10. 11. 12. 13.

c ill-tempered/disagreeable d. only remaining option/last hope for assistance sleep apnea e. (short for) Down Syndrome (a person with extra 21st chromosome) obese f. loud sound made during sleeping Down’s g. to draw in the breath sharply,as from shock last resort h. least bothersome/least troublesome least intrusive i. overactive guard j. solid/fixed diagnosis (100%) unobstructed k. giving a child too much attention and everything he/she wants firm diagnosis l. temporary breathing interruption (stopping) during sleep spoil m. very fat/dangerously fat

Comprehension Questions 1. Where is this conversation taking place? 2. Why did the mother think it necessary to take her daughter to the doctor? 92

3. What condition does the doctor believe the daughter has? 4. Why is this girl susceptible to sleep apnea? 5. What treatment does the doctor suggest? Why does he think it’s better than a facemask? 6. How will they diagnose the girl’s condition? 7. Discuss what you know about sleep apnea.

9. Tuberculosis (TB) Margaret has just returned from Africa, where she spent her summer doing volunteer work in an orphanage. She visits her doctor due to a persistent cough. Margaret: Hello Doctor. I hope you can give me something for my cough. Doctor: Hi Margaret, haven’t seen you for a long time. If I remember correctly, you have just returned from Kenya.

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M: That’s right. Everything was great until a month ago when I developed this nagging cough with bloody sputum; it doesn’t want to go away. Dr.: Any other changes in your condition? M: I feel pretty fatigued and don’t have very much of an appetite. I think I’ve lost some weight. I wonder if I’ve developed bronchitis? Dr.: I can’t tell just yet. Any aches or pains? M: Yes, when I cough or when I take a deep breath. Dr.: I’d like to give you a saliva test as well as a Mantoux test. This test involves injecting the tuberculin protein into your skin. The results can be reviewed just in 48 hours. Have you ever been vaccinated for TB? M: No, I haven’t. Do you suspect that I have TB? Dr.: Yes, your persistent cough as well as your other symptoms point to TB. A positive result would mean that you have developed TB. I’ll send you to the lab. I’ll see you back in 2 days. In the meantime, I’d like you to stay home. Please don’t share any eating 94

utensils or anything else that would make TB transmission possible. Please come back in two days.

TUBERCULOSIS Match the numbers with the letters 1. orphanage 2. persistent 3. nagging

a. persistent/continuing b. knives, forks, spoons etc... c. a home for children without parents 4. sputum d. saliva (spit) mixed with mucus 5. fatigue e. test for TB 6. bronchitis f. transfer/passage/spreading 7. Mantoux test g. continuing 8. review h. in the time between two things happening/meanwhile 9. meantime i. inspect/check 10. utensils j. being tired/weariness from bodily or mental exertion 11. transmission k. inflammation of the bronchial tubes

Comprehension Questions 1. Why is Margaret seeking medical attention? 2. What are her symptoms? 95

3. What tests does her doctor suggest for her? 4. How are the tests done? 5. When will Margaret get the results from the tests? 6. What does the doctor recommend that Margaret do in the meanwhile?

10. Acute Bronchitis Mark Stuart has brought his 12-year-old son Jamie to their family doctor. Doctor Gray: Good afternoon, Mr. Stuart. Hi Jamie. What can I do for you today? Mark: Well, Jamie’s got a cough that won’t go away. Dr.: I see; when did this come on? M: A few days ago. Before that, he had a bad cold and an earache. Dr.: Has he had a fever? 96

M: Yes, a mild one. And he’s weak and tired. Dr.: Is his cough a dry cough? M: It was at first, but now he’s coughing up phlegm with it. And he’s coughing so much, it keeps him up at night, and the rest of us too. Dr.: Is there any blood in the sputum? M: Not that I’ve noticed. Dr.: Any wheezing or shortness of breath? M: Both. Dr.: Right, Jamie, let’s have a listen to your chest. Big breath in…and out. Again. Really big breath this time…Once more, in…and out. Good. M: Well? Dr.: I suspect it’s bronchitis, he’s showing all the signs. We can do a culture on the sputum to determine if it’s viral or bacterial bronchitis. It’s most likely viral. That means we treat it with bed rest and lots of liquids. M: For how long? 97

Dr.: It usually takes about 10 days or so, but the cough may persist for a while after that.

ACUTE BRONCHITIS Match the numbers with the letters 1. 2.

when did this come on? phlegm

3.

sputum

4. 5.

wheezing shortness of breath 6. suspect 7. bronchitis 8. culture 9. determine 10. persist

a. can’t breathe easily b. infection of the bronchial tubes (airway) c. to breathe with a whistling sound d. continue e. when did this start? f. decide g. thick mucus h. saliva with mucus i. I think (but not 100% sure) j. to grow the bacteria in the sputum in a petri dish & in a lab

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Comprehension Questions 1. Where is this conversation taking place? 2. Who is the patient? 3. What symptoms does he have? Give details. 4. What previous condition did he have? 5. What current condition does the doctor suspect? Why? 6. What should the patient do to get better? 7. Discuss what you know about bronchitis.

11. Pneumonia Sara Coleridge is an elderly patient confined to her rural home. Her son has alerted the local GP (family doctor) since Sara’s condition has deteriorated. Sam: Good morning Doctor Gillman. Thank you for coming so quickly. 99

Doctor: Good morning, Sam. Let’s have a look at your mom, here. I gather she’s had a cold. S: Yes, these last couple of weeks, and now it’s worse. Dr.: Right. Let’s have a listen to her chest. Can you sit up for me, Mrs. Coleridge? That’s it. (to Sam): Is she coughing? S: Yes, quite a bit. And there’s yellow phlegm. Dr.: Fever? S: Yes, and chills with it. And she can’t seem to get her breath, even when she’s just sitting up in bed. Dr.: Has she had any chest pain? S: Seems like it. She clutches her chest when she coughs. Dr.: She’s a bit cyanotic by the looks of things and that’s not good. S: What does that mean?

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Dr.: You see that slight bluish tinge around her lips? Didn’t you notice it? That means she’s lacking oxygen. S: I’m not here all the time, you know. I’ve got my own family to take care of. Dr.: You’re going to have to consider getting some permanent medical help for her, but we can discuss that later. In the meantime, I’m going to admit (send her to a hospital as an in-patient) her to hospital today. It looks like she’s got pneumonia (lung infection), and she needs immediate care. S: Right.

PNEUMONIA Match the numbers with the letters 1. 2. 3. 4.

confine rural to alert deteriorate

5. 6. 7.

I gather phlegm chills

a. thick mucus b. warn to prepare for action c. countryside/outside the city d. little bit of bluish (blue) coloration e. a sensation of coldness, f. restricted/limited g. I understand 101

8. clutches 9. cyanotic 10. slight bluish tinge 11. lack 12. consider

h. to hold tightly or firmly i. not enough j. think k. get worse gradually l. blueness of the skin (as from lack of oxygen in blood)

Comprehension Questions 1. Where is this scenario taking place? 2. Describe the situation of this patient’s care in detail. 3. Who alerted the doctor? 4. What are the patient’s symptoms? Give complete details. 5. What condition does the doctor suspect? 6. Why is the doctor a bit upset with the patient’s son?

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7. Why is the doctor not talking to the patient herself? 8. Discuss what you know about pneumonia

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Answers 1. ASTHMA Match the numbers with the letters 1.

wheeze

2. 3.

out of shape eczema

4.

asthma

5.

by the sounds of it a. sounds/looks/appears to be confirm b. verify/prove hunch n. educated guess get to the bottom of this h. to discover the truth about something/to find the cause. thorough k. complete/detailed meantime l. the time between one occurrence and another; an interval/meanwhile prescribe i. doctor orders treatment carry on o. continue overdo e. do too much on the way out m. when you leave

6. 7. 8. 9. 10. 11. 12. 13. 14.

d. to breathe with difficulty and with a whistling sound g. not physically fit j. an inflammatory condition of the skin f. often allergic disorder of respiration

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15. crucial

c. very important

Answers 2. CROUP Match the numbers with the letters 1.

pediatrician

2. 3. 4.

still classic sign croup

5. 6.

appears moderate

7. 8.

observation nebulizer

9. ensure 10. precaution

d. doctor who specializes in children’s care e. not moving l. typical sign b. respiratory condition in which the person has hoarse (rough) cough and difficulty breathing a. seems g. not extreme/within reasonable limits j. monitoring and noticing f. a spray used by people who have trouble breathing h. make sure i. an action taken in advance to protect against possible danger 105

11. better safe than sorry

k. it is better to act carefully beforehand than to suffer afterward.

Answers 3. CYSTIC FIBROSIS - (CF) Match the numbers with the letters 1. 2.

concern infant

3. 4.

chronic preemie

5. 6. 7.

resistant environment incubator

8.

sterile

h. worry b. a baby before he/she can walk f. long term/long lasting i. a baby born too early /premature c. to fight against/defend a. our surroundings j. an enclosed apparatus in which prematurely born infants are kept in controlled conditions, (such as temperature), for protection and care. e. without germs and bacteria /very clean 106

9.

worst case scenario

10. thorough

d. the worst thing that could possibly happen g. complete/detailed

Answers 4. EMPHYSEMA Match the numbers with the letters 1. How have you been keeping? 2. feeling rather poorly 3. angina 4. out of puff 5. get me through 6. taken a toll 7. emphysema 8. degenerative 9. admit (to hospital)

f. How have you been feeling? a. not feeling well at all j. chest pain e. short of breath/can´t breathe easily g. help me cope or manage b. to have a bad effect on someone or something d. a respiratory disease where the air sacs rupture i. getting worse little by little h. check a person into a hospital for tests /treatment 107

10. rule out

c. eliminate (remove) from consideration

Answers 5. PNEUMONIA Match the numbers with the letters 1 frankly 2. greenish 3. phlegm 4. onset 5. exhale 6. crackling 7. rales 8. rumblings

9. mucus 10.pneumonia 11. we are dealing with

j. honestly d. green-like color k. thick mucus f. start/beginning l. breath out b. to make slight, sudden sharp noises, rapidly repeated (like frying something) g. an abnormal respiratory sound characterized by fine crackles m. course rattling sound a little bit like snoring, usually caused by secretions in the bronchial airways a. thick sputum h. lung inflammation c. you have 108

12. entire course of antibiotics 13. resistant

e. all of the antibiotics i. fight against

Answers 6. PNEUMOTHORAX Match the numbers with the letters 1.

mechanical ventilator

2. 3. 4. 5. 6. 7. 8.

vent struggle clutch indicate shoulder blade hypoxic pneumothorax

9. certainly 10. we´re dealing with

e. a respirator/a machine that helps a person breathe h. (short for) ventilator c. fight f. to hold tightly or firmly a. show l. the scapula b. lack of oxygen j. the presence of air or gas in the pleural cavity d. really/surely/indeed g. you have/the diagnosis is/what we are working with 109

11. accompany 12. goes downhill 13. on hand

m. go together with someone i. gets worse k. available

Answers 7. PULMONARY EMBOLISM Match the numbers with the letters 1. I’ll take that as a “no”. 2. move around 3. thrombosis 4. embolism

5. remain immobile 6. crutches 7. good

f. I guess the answer is NO. a. move about/move c. a clot in a blood vessel g. obstruction or occlusion of a blood vessel by a mass, such as an air bubble, a detached blood clot etc. e. stay motionless/not moving d. support used for walking b. unaffected/not affected

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Answers 8. SLEEP APNEA Match the numbers with the letters 1. hyper 2. cranky 3. snoring 4. gasping 5. sleep apnea 6. obese 7. Down’s 8. last resort 9. least intrusive 10. guard 11. unobstructed 12. firm diagnosis 13. spoil

i. overactive c. ill-tempered/disagreeable f. loud sound made during sleeping g. to draw in the breath sharply, as from shock l. temporary breathing interruption during sleep m. very fat/dangerously fat e. (short for) Down Syndrome (a person with an extra 21stchromosome) d. only remaining option/last hope for assistance h. least bothersome/least troublesome a. protection b. not blocked j. solid/fixed diagnosis (100%) k. giving a child too much attention and everything he/she wants 111

Answers 9. TUBERCULOSIS Match the numbers with the letters 1.

orphanage

2. 3. 4.

persistent nagging sputum

5.

fatigue

6.

bronchitis

7. 8. 9.

Mantoux test review meantime

10. utensils 11. transmission

c. a home for children without parents g. continuing a. persistent/continuing d. saliva (spit) mixed with mucus j. being tired/weariness from bodily or mental exertion k. inflammation of the bronchial tubes e. test for TB i. inspect/check h. in the time between two things happening/meanwhile b. knives, forks, spoons etc. f. transfer/passage/spreading

Answers 10. ACUTE BRONCHITIS Match the numbers with the letters 112

1. when did this come on? 2. phlegm 3. sputum 4. wheezing 5. shortness of breath 6. suspect 7. bronchitis 8. culture 9. determine 10. persist

e. when did this start? g. thick mucus h. saliva with mucus c. to breathe with a whistling sound a. can’t breathe easily i. I think (but not 100% sure) b. infection of the bronchial tubes (airway) j. to grow the bacteria in the sputum in a petri dish & in a lab f. decide d. continue

Answers 11. PNEUMONIA Match the numbers with the letters 1. 2. 3. 4. 5.

confine rural to alert deteriorate I gather

f. restricted/limited c. countryside/outside the city b. warn to prepare for action k. get worse gradually g. I understand 113

6. 7. 8. 9.

phlegm chills clutches cyanotic

10. slight bluish tinge 11. lack 12. consider

a. thick mucus e. a sensation of coldness, h. to hold tightly or firmly l. blueness of the skin (as from lack of oxygen in blood) d. little bit of bluish (blue) coloration i. not enough j. think

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Copyright (c) All rights reserved. The use of any part of this publication reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, or stored in a retrieval system, without the prior written consent of the publisher is an infringement of the copyright law. ISBN 978-1-7770385-9-5 Published by The Vancouver Medical English Institute 2020 Pikku Vichert 115

Study Medical English with other books in the series: (all with imbedded audio) Volume 1 Reproductive System

Volume 2 Musculoskeletal System

Volume 3 Immune, Autoimmune and Genetic Conditions

Volume 4 Interviewing, Surgery and Procedures

Volume 5 Neurological Conditions

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Volume 6 Skin and Communicable Conditions

Volume 7 Blood, Heart, Liver and Viral Conditions

Volume 8 Eye, Ear and Oral Conditions

Volume 9 Urinary System

Volume 10 Respiratory Conditions

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Volume 11 Nutrition, and Digestive Conditions

Volume 12 Endocrine Conditions

Volume 13 Cancers, Palliative and Geriatric Care

Volume 14 Mental Conditions

email Pikku at [email protected] She can help you continue Medical English in your specialty.

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Acknowledgements In my journey towards creating these e-books I have come to realize that without the constant support and encouragement of my friends, family and students these books would only be an unrealized dream. I´d like to acknowledge my gratitude to Sara Jackson, nurse and friend, who for years taught this material and shared her expertise in the nursing related dialogues encountered in these books. I am privileged to have received insightful guidance and encouragement from Evelyn Reiss, a special educator and a lifelong friend, whose confidence in me never seemed to waver. Debbie Fleischaker is another lifetime friend to whom I am indebted for putting up with my many questions throughout this process. Of course, I take great pleasure in acknowledging the feedback from the many medical professionals who have taken this course. I will forever be in their debt. Without them, these books would never exist, and I would never have had the pleasure of creating or improving them. 119

A special thanks to Dr. Dan Kingsbury and his wife Bronia who were instrumental in creating the name for this series, to my brother-in-law Erkki Pesonen, who advised about constructing the cover and Dr. Paz Tornero for helping with cover designs using the colors of 2020. Throughout this entire process, my son Nikko, has supported me with the recordings found in these books, but by far my biggest impetus has come from my husband Alan Vichert, who has been an inexhaustible source of engaging ideas to keep me focused.

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Student’s comments cont´d: What I really wanted was to improve my English conversation skills, and also, I wanted to learn how to communicate with patients and other health care givers in English. Yumiko Mizuno - Pediatrician She also gives special hints and recipes which make it interesting and exciting to learn a foreign language I absolutely had fun, although my study was so hard. I am definitely sure that her system is for students who really want to learn'”. Mitsuru Nakajima - Nurse, Minato-ku, Tokyo She knows not only how to teach medical English, but also English language. She understood we already knew about medicine in our own language, so she had us explain it in English. Sachiko Oka - Pharmacist, Vancouver What I learned is not just new words or new medical terms but also how to use English, how to use all my knowledge of English and built up my confidence to speak! By the time I finished, I could even enjoy jokes too. Mine Takamatsu - Nurse 121

I could feel that my English skill improved. I could learn not only medical English but also general English. Yumiko Aoyagi - Nurse, Vancouver I studied medical terminology for two months before starting this course, but I wanted to use it in conversation. I discovered that in Pikku’s course speaking was the main subject, such as role plays (patients, doctors and nurses). I learned many medical words but also general words, naturally. Maki Nagasaki - Nurse I learned to put my thoughts into English, because the same words and idioms were used repeatedly. I was able to learn them in a natural way. In addition, I was interested in other medical fields and I learned about many different areas of medicine. Miuki Miyahara - Nurse I felt my English improved dramatically. Tomoko Okada - Nurse All of the things I learned and experienced were authentic and valuable. Natsumi Takata - Massage Therapist

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I always felt safe making lots of mistakes. On top of that, I always had fun! Having fun is the best way to learn Akiko Kurosawa - Medical Office Assistant Pikku makes sure we learn how to think in English and how to use English. Mohammed Al-Yousef - Doctor, Dammam, Saudi Arabia She taught us not only Medical English but also regular English. She can speak several languages. It means she knows how to learn foreign languages, and what is the best way to study foreign languages. Mayumi Uchida - Nurse VMEI is for those who want to understand and learn English and enjoy the learning process. I am very happy with the results I got. Hashim Al-Hassan - Doctor

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