"WHAT'S UP DOC?"

INTRODUCTION

This unit is designed to acquaint you with the symptoms, diagnostic procedures, treatment and prevention of diseases and injuries associated with the respiratory, skeletal, circulatory and muscular systems of the human body. For the purposes of this assignment, you are asked to assume the personas of a physician and a patient or an associate of someone who has a specific medical problem. In the role of the latter, you will describe your symptoms to another student playing the role of a physician*. When you assume the persona of a physician, you will need to provide the following information to your “patient”: 1 an accurate diagnosis, 2. an explanation of what is wrong with the patient, 3. a description of diagnostic procedures or tests that are needed to confirm your diagnosis, 4. recommended treatment to cure or alleviate the condition and 5. any preventive measures.

As part of this assignment, you will complete the following:

1. Look up information about your condition or disease in appropriate books, Web sites and magazine databases.
2. Complete a medical chart that you can refer to that contains an understandable description of the disease or condition, an explanation of how it effects one of the human body systems (respiratory, circulatory, muscular or skeletal), a description of appropriate diagnostic tests or procedures, recommended treatment and preventive measures.
3. Footnote all sources including Web sites and attach a bibliography.
4. Make an oral presentation no longer than 3 minutes to the class about your assigned disease or condition.

Syllabus

Day 1 Introduction to the unit. Research reserve materials in the library. Hand in two sources (book, Web sites, or magazine articles) that you intend to use to complete your medical chart.

Day 2 Continue research in the library. Hand in an outline of your assignment to either Ms. Basile or Ms. De Yonker by the end of the period.

Day 3 Continue research in the library Finish completing the medical chart and prepare for your oral presentation the following day.

Days 4-5 Make presentation in classroom according to assigned schedule.

Research Hints

•  Underline the keywords in your assignment. Make a list of them and look up appropriate synonyms.

1. Use these words to search the indexes of books on the reserve cart, Web sites in Eagle Eyes (use keyword “DeYonker” to obtan a list of appropriate sites) and two magazine databases (Ebsco's Host and SIRS). **Remember to click the full-text search box for Ebsco's Host when doing your searches.
2. Your search strategy should include the medical or popular term in quotation marks followed by either a + sign (if you are using Google.com or the word < and> if you are using Ebsco's Host or SIRS.
   Example for Ebsco's Host or SIRS = “tennis elbow” and causes Example for Google.com “tennis elbow” +causesRemember to use the medical or popular term for the disease or condition with search words such as causes, symptoms, treatment, or prevention.
   
3. Check out any additional materials that you locate in any of the Close libraries by the end of the first day. We have a courier system to assist you with retrieval of non-NCSU books.
4. Save your research by following the directions taped to the computer desk that you are working on. Use the same computer each day so that you can access any information that you saved on to the desktop.
5. Consult the “Citation Format” link on the NCS Upper School Library homepage for the correct way to cite the books, Web sites, and magazine articles that you used.

QUESTIONS

Tennis Elbow – patient scenario
You are thirteen years old and have been experiencing inflammation and pain near the bone on the outside of the elbow. This past summer you went to a tennis camp and now are playing indoor tennis at a local country club. The pain extends down to your wrist and it is painful for you to shake hands or lift your book bag.

Tennis Elbow – physician scenario
A thirteen-year-old patient is complaining of pain near the outside of her elbow. After asking some questions, you have diagnosed the pain as a condition known popularly as “tennis elbow' and medically as “tendinitis”. The patient has never heard of tennis elbow. You must explain it to her so that she understands what it is and how it affects the muscular system. What do you recommend that she do to alleviate the pain? Once the injury heals, is there something that you recommend she do to prevent further occurrences of tennis elbow?

Sources: Harvard Medical Dictionary Family Health Guide p. 616; Web site “Tennis Elbow A Guide to the Treatment and Prevention of Tennis Elbow! Http://www.thestretchinghandbook.com/archives/tennis-elbow.htm; SIRS several articles under “Tennis Elbow” and causes and in Ebsco's Host under “tennis elbow and prevention”.

Muscular dystrophy – patient scenario
Your favorite male cousin has been so clumsy lately. Recently when you were playing soccer together, his legs just seemed to go out from under him and he fell flat on the ground. Your aunt called after his fall to tell your family that he has muscular dystrophy. You are curious to know what your chances are of catching this disease? Is it genetic? Could you be a carrier? What treatments are available, if any? What work is being done with gene therapy? What are your cousin's chances for leading a normal life?

Muscular dystrophy –physician scenario
You favorite niece comes over to your office and tells you that her cousin has been diagnosed with muscular dystrophy. You must explain to her what this disease is all about and how it affects the muscular system. She wants to know if she could be a carrier. What treatments are available for this disease? Tell her about any promising treatments involving gene therapy. She wants to know what her cousin's chances are for leading a normal life too.

Sources: Body by Design Vol. 1 p. 168; Harvard Medical School Family Guide p. 610-612; Web site NINDS Muscular Dystrophy (MD) Information Page
http://www.ninds.nih.gov/health_and_medical/disorders/md.htm and Medline Plus Health Information Muscular Dystrophy
http://www.nlm.nih.gov/medlineplus/ency/article/001190.htm
Ebsco's Host under muscular dystrophy and symptoms and muscular dystrophy and treatment; SIRS under muscular dystrophy and treatment or cure, etc.

Scoliosis-patient scenario
During a break in ballet class, your best friend tells you that her cousin, who's also twelve-years-old, has to wear a body brace because she has “scoliosis.” You think to yourself that this sounds really random and a little frightening, but worry it could happen to you. Thank goodness your routine check-up is scheduled for next week! At your doctor's appointment, you ask your pediatrician about scoliosis.

Scoliosis-physician scenario
A twelve-year-old girl is coming in for a routine check-up. Surprisingly, she asks you about scoliosis and recites her friend's story. As her physician, you explain this routine check for scoliosis and why and how it is done. You tell your patient what you're looking for in her. As you proceed with the exam, you do detect a slight S curve in her back. Tell her what you found and how it relates to her spine. Explain how scoliosis will be treated and evaluated during her growth years. Explain why a brace wouldn't be appropriate for your patient, but why it may be for her friend's cousin .

Sources: The Harvard Guide to Women's Health, pp. 547-550; Web site “Kids Health” http://www.kidshealth.org/teen/diseases_conditions/bones/scoliosis.html ; Ebsco's Host, several articles under scoliosis.

Tetanus – Patient Scenario
You and your friend were mucking out your horse's stall when the pitchfork pricked the back of your left leg. Your friend asked you if you've had a tetanus shot lately, but you just laughed and told her that you can only get tetanus from a rusty nail. Five days later the back of your left leg has turned as red as a chili pepper and you feel feverish. You are afraid that you have lockjaw and decide to consult a doctor.

Tetanus – Physician Scenario
Your first patient of the morning is a 14 year-old girl who shows you a bright red swelling on the back of her left leg. After listening to her explanation for the infection, you conclude that she has tetanus or “lockjaw”. Event though she has heard of the term, she doesn't understand the nature of the disease. Explain what tetanus is and how it affects the muscular system. How does one get tetanus? What treatments are there to cure it? What should she do to prevent getting it in the future?

Sources: Harvard Medical School Family Health Guide p. 879-880; Body by Design Vol. 1 p. 170-171; Web sites: Lycos Health with WebMD http://webmd.lycos.com/content/article/1680.53926
Tetanus -symptoms
http://sprojects.mmip.mcgill.ca/tropmed/tropmed2001/disease/tetanus/tetanus.htm Ebsco's Host - under tetanus and symptoms and tetanus and treatment ; SIRS under tetanus and symptoms and tetanus and treatment.

Osteoporosis—patient scenario
Finally, you've turned 13! No longer a kid, your favorite first cousin asks you to be a bridesmaid in her wedding. The big day arrives, and you're getting ready with the rest of the bridal party. Jo, another cousin in the party, starts talking about “the family.” She asks you if you've noticed how Auntie Phyllis, Aunt Mary and Grandma have all shrunk! (You ‘d better take a closer look at the reception.) She goes on to mention how they all have “osteoporosis,” and that you'd better be careful or you'll end up that way, too! Are you doomed to this fate? You decide to ask you doctor at your next check-up.

Osteoporosis—physician scenario
A thirteen-year-old patient asks about osteoporosis during a routine physical. She mentions how her maternal great aunts and maternal grandmother look as if they've shrunk, and how one even has a hump back. Explain to her what is happening to her relatives' bones, but also explain the general composition of bones and the remodeling process. Explain the preventive measures she can take now, as a thirteen-year-old, and how these measures would affect her bones. List some of the risk factors (i.e., biological, medical, lifestyle and environmental) of the disease, too. Assure your patient that her aunts and grandmother are probably on medications and tell her what some of those medications are.

Sources: Ourselves, Growing Older, pp. 260-269; Web Site “National Osteoporosis Foundation” http://www.nof.org ; SIRS several articles under “osteoporosis” and risk factors and in Ebsco's Host under “osteoporosis” and prevention.

Sprains & Fractures—patient scenario
It's November 15 th . Harry Potter & The Chamber of Secrets is now playing at the local theater. You scored tickets online, are at the theater and running up the stairs to find a prime balcony seat. You trip on the last step. Sno caps go flying in every direction, and you fall onto the very hard floor. Stunned, you try to stand up, but have intense pain and swelling in your right ankle. You cannot put any weight on it. The friends you're with help you up and comment on how pale you look. The theater manager calls your parents.

Sprains & Fractures— physician scenario
A twelve-year-old patient is carried into the emergency room by her parents. The patient's right ankle is swollen, and she's in a great deal of pain. She cannot stand using that ankle. After initial examination, you think the ankle is fractured, not sprained. Tell her worried parents the difference between the two, and why you suspect a fracture. An x-ray confirms your diagnosis of a fracture, and shows a crack on one side of the fibula bone. What kind of fracture is this, and how is it different from other fractures? Explain how bones respond in an emergency. Also, what is your patient's course and expected duration of treatment?

Sources: Bones, pp. 9-10, p.37, p.41, p.49; Web Site http://orthopedics.about.com/cs/lowerfx/ ; Web Site http://www.imcpl.lib.in.us/kids_skel.htm ; SIRS, several articles under “fractures” and bones, and in Ebsco's Host under “sprains” and bones.

Muscle strain – patient scenario
You and your sister were fooling around in your bedroom when your sister dared you to leap off your bed and land in a split on the floor. You took the dare and when you did the splits you felt all of your inner thigh muscles pull. Now you can hardly walk.

Muscle strain –physician scenario
A thirteen-year-old patient limps into your office. She can hardly walk and has to hold the back of a chair before she can ease herself down onto it. All the muscles in both inner thighs are throbbing and aching. You must explain to her that she has strained all of her thigh adductor muscles. Since your patient has never taken a course in anatomy, you must tell her the names of these muscles and demonstrate their origin and insertion on the thigh bone. What treatment do you recommend to relieve her pain? How could she have prevented such a severe muscle strain? Show her some exercises for stretching the thigh adductor muscles.

Sources: Body by Design V. 1 p. 170; Muscles: The Magic of Motion p. 156 (Glossary definition), p. 132, 154. Web site: Questions and Answers about Sprains and Strains http://www.niams.nih.gov/hi/topics/strain_sprain/strain_sprain.htm
Groin Strain (Adductor Muscle Rupture) http://www.sportsinjuryclinic.net/cybertherapist/front/frontthigh/
adductrupture.htm; Ebsco's Host under muscle strain and treatment and muscle strain and symptoms. SIRS is not helpful for this question.

Flu- patient scenario
You wake up in the morning with chills, a fever of 102 degrees and a headache. You are also sneezing and have a sore throat. You think that you should just stay home until you feel better, but your mother has other ideas. She thinks that you may have some infection and just need some antibiotics. She makes an appointment for you to see a doctor.

Flu- physician scenario
Your patient is 13 years-old. She is shivering and has a temperature of 102 degrees. Her complaints also include a sore throat, headache and muscle aches. You diagnose that she has influenza or the flu. Her mother is insistent that she be prescribed antibiotics. You must explain to your patient how the flu effects her respiratory system. What complications should she watch out for? How should she treat her current symptoms? Are there any over-the counter remedies that you might recommend? Why do you refuse to treat her with antibiotics?

Sources: Books Harvard Medical School Family Health Guide p. 875-876; American Medical Association Family Medical Guide p. 597-598 Web sites Influenza http://www.nlm.nih.gov/medlineplus/influenza.html Ebsco's Host under influence and treatment; influenza and symptoms; SIRS under influenza and treatment and influenza and symptoms.

Rheumatoid Arthritis—patient scenario
An Upper School student you know is soliciting pledges for a 10 mile walk benefiting arthritis research. You decide to pledge a dollar for every mile she walks. Grateful, she gives you the information packet and tells the story of her older sister who suffers from rheumatoid arthritis (RA). You're surprised since you know her sister recently graduated from college. Isn't arthritis a disease that affects senior citizens? You'll ask your doctor next time you go.

Rheumatoid Arthritis—physician scenario
A twelve-year-old girl comes in for her yearly physical. You are performing the normal checks when she asks about rheumatoid arthritis. You ask if she's experiencing pain. She's not, but tells you about the twenty-something-year-old who has the disease. You explain what the disease is and how it affects the body's joints, what causes RA, and what the effects are. Tell your patient RA's symptoms. Explain how the disease is diagnosed and the treatment options available. Don't forget to talk about “lifestyle” in relation to RA, and measures patients can take to live a better life.

Sources: The Human Body, p.45; Ourselves, Growing Older, pp.254-255; Web Site “The Arthritis Foundation” http://www.arthritis.org/conditions/DiseaseCenter/ra.asp ; SIRS, several articles under “rheumatoid arthritis” and treatment, and in Ebsco's Host under “rheumatoid arthritis” and diagnosis.

Anemia – patient scenario
You are fourteen years old and have been really tired lately, but you thought that maybe it was just because of your period. Yesterday, there was a sale on the pink and orange Adidas that you have wanted forever, but when you were running up the escalator at the mall, you got all out of breath. You also have had headaches that concentrate in the front of your head. Recently, you decided to become a vegetarian…. but you haven't actually eaten any vegetables for the past 2 weeks. Could a diet exclusively of corn chips and cola have anything to do with this?

Anemia – physician scenario
A fourteen-year-old patient is complaining of a frontal headache, shortness of breath, and fatigue. After asking her a few questions, you perform a blood test and diagnose her as anemic. She is not sure what this is, so you must explain her condition to her. What is happening to her body? How does one become anemic, and are there any preventative measures that can be taken against it? Can she be cured? Is this a common blood disorder? Explain.

Sources: The New Teenage Body Book p.173-174; The Ms. Guide to a Women's Health p. 368-371; Web site “MEDLINEplus: Iron Deficiency Anemia” http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm ; Web site “Anemia,” KidsHealth.org http://health.yahoo.com/search/healthnews?lb=s&p=id%3A20284 ; SIRS has a relevant article under “anemia” and Ebsco's Host has several under “anemia and causes.”

Emphysema – patient scenario
You are fifteen years old and have been smoking for three years. At first, you just sneaked cigarettes from your parents, but now your friend Gordon is 18 and he can buy them for you, so you have been smoking pretty regularly. In class, you have been studying the respiratory system and the science teacher showed a photo of the lungs of someone with “emphysema”. Even you have to admit, it totally grossed you out and made you kind of nervous. You have not been able to kick the cold that you've had for the past month, and you start to wonder if you could have lung damage already. When you get winded chasing after your cat as she bolts for the door, you figure it's time to go to the doctor and fess up.

Emphysema – physician scenario
A fifteen-year-old patient is complaining of chronic cold symptoms. Although you conclude that this is a case of bronchitis, she has commented that she smokes and is concerned about “emphysema,” a chronic obstructive pulmonary disease. Address her concerns, and advise her to do what is best for her health. Explain what emphysema is and how it effects the respiratory system. What kinds of symptoms would someone with “emphysema” experience? How would their lung health be determined? Is “emphysema” curable or treatable? What can she do, if anything, to help prevent it?

Sources: Respiration, The Breath of Life p.68-71, 74-76;
Web Site “University of Maryland Medicine: Emphysema” http://www.umm.edu/imagepage/17055.htm ; Web Site “Canadian Lung Association: Emphysema” http://www.lung.ca/children/grades7_12/lung_health/emphysema.html; Web site “Emphysema” http://health.yahoo.com/health/encyclopedia/000136/0.html ; several articles in SIRS under “Emphysema” and in EBSCO's Host under “emphysema and breath*.”

Bronchitis – patient scenario
You are fourteen years old, and recently, you have been feeling tired and have a sore throat. You have had a cough for the past few days, but now you have also started to cough up yellowish mucus. Also, your mother tells you that you have been breathing loudly at night. Last week, you stayed with your best friend's family, and her annoying little brother coughed a lot. Now your best friend has begun coughing, too.

Bronchitis – physician scenario
A fourteen-year-old patient comes into your office complaining of a productive cough, wheezing, a sore throat, and malaise. After speaking with her about the symptoms and conducting a physical examination, you diagnose her condition as “bronchitis”. Your patient doesn't understand what this means, so you must explain what bronchitis is and its effect on the respiratory system. Will you take any additional tests or prescribe something? Which type of bronchitis is this likely to be? What do you suggest that she do to alleviate her symptoms? Is there any way she can prevent another outbreak?

Sources: Parker, Steve. The Human Body: The Lungs and Respiratory System p.40-41; The Doctor's Book of Home Remedies p.113-116; Web site “Acute Bronchitis” http://health.yahoo.com/health/encyclopedia/000124/0.html ; Web site “Acute Bronchitis: What You Need to Know” http://www.aafp.org/afp/980315ap/980315a.html ; Sorting Cold and Flu Myth from Fact , PATRIOT LEDGER Jan. 12-13, 2002, p. 6; Ebsco's Host under “bronchitis” and “bronchitis and causes.”

Hypertension – patient scenario
You are twelve years old and are worried because your mom's sister called her and was discussing her most recent visit to the doctor. She says has been diagnosed with “hypertension,” just like Uncle Bob. You are pretty sure that this doesn't mean she's just stressed from being too rowdy, because Aunt Hilde doesn't like any sports other than marathon shopping. However, you are not exactly sure what it DOES mean. What systems are effected by it? Can she be cured, and is there anything you can do to help? Does that mean you are at higher risk of getting it?

Hypertension – physician scenario
A concerned patient comes into your office with questions about a relative with “hypertension,” more commonly known as “high blood pressure.” Comfort her, and explain the condition to her in terminology that she can understand. What exactly is hypertension and how is the circulatory system effected? How is it diagnosed? Are there any symptoms? Is there anything that can be done to remedy the condition? Is “hypertension” hereditary, and what can the patient do to prevent “high blood pressure”?

Sources: Clayman, Charles ed. The Human Body p.121; Home Remedies for Preventing Disease p.335-p.342; The Harvard Guide to Women's Health p.292-296; Web sites http://health.yahoo.com/health/encyclopedia/000468/0.html and http://health.yahoo.com/health/centers/vital_signs/8.html ; Web site “High Blood Pressure: Enemy #1 in the African American Community” http://www.blackwomenshealth.com/hypertension.htm ; Ebsco's Host under “hypertension” and prevention, and “hypertension” and treatment.

Sickle cell anemia – patient scenario
You are fifteen years old and were watching television with a friend, when one of the members of TLC comes on and starts talking about having sickle cell anemia. You have no idea what this is or how you get it, but your friend says that her father has it, and that she has the sickle cell trait, too. You borrowed some pierced earrings from her last week, and this makes you start to wonder if you could have caught it from her. You are also concerned about your friend and her family and want to know more about it. On your next visit to the doctor, you decide to ask about the disease and why some people have sickle cell anemia.

Sickle cell anemia – physician scenario
A fifteen-year-old patient arrives in your office with questions about “sickle cell anemia”. She is concerned that it is a transferable disease and wants to know more about it. Inform her about the disease, and assure her that it can't be ‘caught'. Let her know what a “sickle cell” is and how it effects the circulatory system. Use a visual aide, if possible. Explain who is at risk of the disease, and how it is detected. Also, inform her of the treatment and what those with sickle cells should do to take care of themselves.

Sources: Blood, The River of Life p.135-139; Harvard Family
Medical School Family Health Guide , p. 721-722; Web site
“Sickle Cell Disease” http://sickle.bwh.harvard.edu/menu_sickle.html ; Web site "SCDAA: What Is Sickle Cell Disease?" http://sicklecelldisease.org/what_is.htm ; Web site “Sickle Cell Kids” http://www.sicklecellkids.org/ ; Ebsco's Host under "sickle cell anemia and African American"; and SIRS under "sickle cell anemia".

Hemophilia – patient scenario
In your seventh grade history class, you are studying the British monarchy and “hemophilia” is mentioned. You learn that it is a blood disease that some royalty appeared to have, but other than that you are clueless and you figure it must be extinct. This makes you very surprised when you learn that your neighbor's little boy is undergoing tests for it. How is this possible? Does this mean he's undercover royalty? What exactly is hemophilia? How do they test for it? Is there a cure? You decide that you want to know more and discuss it with your doctor at your next check-up.

Hemophilia – physician scenario
A thirteen-year-old patient mentions “hemophilia” at her most recent office visit. She is curious about the disease because of a neighbor who is undergoing tests for it. She asks you about testing procedures and the disease itself. Explain to her the ways in which “hemophilia” is passed from generation to generation as well as any additional ways in which it can be present in a patient. Who is most susceptible to “hemophilia”, and what are the symptoms? What are its effects on the body, and what are some of the ways in which it is treated?

Sources: Journey p. 33-35,69-76,460-462; Blood, the River of Life p.88-95; Web site “Hemophilia: Pediatrics” http://pediatrics .about.com/library/weekly/aa050600.htm?once=true& ; Web site “Hemophilia: What Is It?” http://www.yourgenesyourhealth .org/ygyh/mason/ygyh.html?syndrome=hemo ; Web site “The Bleed Stops Here” http://www.hemophilia.ca/ english/childrenteen/bleed/index.html ; Web site “NHF's Youth World” http://www.nhfyouthworld.org/ ; SIRS under “ Hemophilia and Treatment” and Ebsco's Host under “hemophilia”.

Lung Cancer—patient scenario
You come home from school one day to find your mom in tears. Her best friend from college just called to say she was diagnosed with lung cancer. Marcia, her friend, has been an on and off again smoker since high school. Your mom tells you Marcia has bronchial carcinoma and is unsure if the cancer has metastasized. You're not sure what this all means, but you remember that Marcia didn't look sick when she visited a few months ago. She did seem to have a nagging cough, though. Realizing your mom is upset, you try to change the subject and make her feel better. You have lots of questions about lung cancer but figure you'll ask your doctor during your physical next week.

Lung Cancer—physician scenario
During a routine physical, your twelve-year-old patient asks about lung cancer. She tells you about her mother's friend and the diagnosis of bronchial carcinoma. Explain what bronchial carcinoma is, its symptoms and what the most common cause of the disease is. (A brief overview of lung functions may help facilitate your patient's understanding of the consequences of the disease.) Although your patient can't remember the exact word, you figure out she wants a definition of the word “metastasize.” You explain this and how smoking damages the lungs beginning with the columnar cells in the bronchi to how cancer cells spread. Make sure to cover all symptoms, diagnostic tests and treatments for the disease.

Sources: The Human Body, pp. 148-149; The Lungs & Respiratory System, pp. 18-19; Web Site, The American Lung Association, http://www.lungusa.org/diseases/lungcanc.html (lung cancer) www.lungusa.org/learn (lung functions); SIRS, several articles under “lung cancer” and “treatment” and under Ebsco's Host “lung cancer” and diagnosis.

Pneumonia—patient scenario
Even though you didn't feel well all day, you managed to make it through a full day of school (one quiz, one test and volleyball practice). It's almost dinnertime and you decide to lie in your bed for just a minute before heading to the kitchen. Even though you're under the covers, you're chilled but sweating at the same time. Your chest hurts and you start to cough (the nasty kind of cough that produces mucus!) Your lips are a little bluish. When you don't show up at the table for your favorite dinner of Chinese carryout, your mom comes looking for you. Immediately she takes your temperature and looks dismayed when the thermometer reads 104 degrees. She calls the pediatrician. Luckily, she's still in her office and instructs your mom to bring you in for an exam.

Pneumonia—physician scenario
A twelve-year-old girl comes into your office suffering from the symptoms listed above. You suspect it may be pneumonia. Luckily, her overall health is generally good, and immune system strong. What steps do you take to confirm a diagnosis? After one of these steps, you discover the patient's pneumonia is caused by strep bacteria. What kind of pneumonia is this? What are the treatment options for your patient? What is happening to her lungs? How is this pneumonia different from other forms of pneumonia? Explain to your patient what kind of pneumonia she has and inform her on the other kinds. Make sure to explain what's happening to her lungs and how this infection is spreading. Tell her what kind of medication is required. If she doesn't follow the course of medication, what can happen? Is this serious? Make sure your patient knows the facts!

Sources: Harvard Medical School Family Health Guide, pp. 496-501; Web Site, The American Lung Association, http://www.lungusa.org/diseases/lungpneumoni.html ; SIRS, several articles under “pneumonia” and children and in Ebsco's Host under “pneumonia” and treatment.

Plantar fasciitis – patient scenario
You are one of the best runners on the Middle School Cross Country Team. Yesterday when you got out of bed you experienced intense heel pain in your left foot. It felt as if someone were driving a nail right into the front part of your heel. As you began to walk around, the pain abated only to return right before afternoon track practice. Worried that you won't be able to compete in the annual “Over the River and Through the Cathedral” race, you asked your mother to make you a doctor's appointment.

Plantar fasciitis – physician scenario
It is 9:30 am when a 13-year-old patient walks into your office. Clearly she is embarrassed because she does not exhibit any signs of the pain that caused her to make an appointment. She tells you that every morning a pain in the front of her heel causes her to limp when she gets out of bed. Later in the early afternoon the pain returns and becomes intense enough that she has had to shorten her running stride. At this rate, she is afraid that she will lose the upcoming race. Explain to her that she has plantar fasciitis. What exactly is it? How may she have gotten this inflammation? Recommend and demonstrate some exercises that she can do to alleviate her pain. Advise her regarding the best type of shoes to wear to avoid a reoccurrence.

Sources: Harvard Medical School Family Health Guide, pp. 639-640; The Doctor's Book of Home Remedies for Preventing Disease, pp. 321-323; Web Site: “Plantar Fasciitis” http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10550.html; SIRS several articles under plantar fasciitis and in Ebsco's Host under plantar fasciitis.

Prepared by K. Craver, J. Foust and B. Mullen 11/2002

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