Archive for April, 2006

Breast findings

Breast findings in the over fifty age group revolve about the one consuming thought cancer. Breast cancer accounts for 15,000 deaths yearly in the United States alone, but it is well worth knowing that most breast difficulties are not cancers.

Absent Breast. This is a very unusual inherited condition. It is not considered a disease and has no significance regarding cancer of any source.

Extra Breast (Polymastia). This is not a disease, and more of a curiosity than anything else. Usually, only the nipple is present and found below the normal breast in line with the umbilicus. Extra breasts are not indicative of cancer or of other disease, but are usually removed for cosmetic reasons.

Enlargement (hypertrophy). The greatly enlarged breast may present considerable inconvenience, but has no great significance in disease for the present or future.

Nipple Retraction. A retracted nipple existent since breast development has little significance. However, if the nipple re-

Fig. 39. Nipple retraction of many years usually has no significance, but a recently retracted nipple may mean serious disease.

traction has developed recently, especially at fifty years or more, it may have great significance for malignant disease of the breast. It is the first sign of trouble in about 3 percent of the breast cancers, and demands a physician’s examination immediately.

Pigeon Breast. This deformity is a sharply projecting breastbone resembling the protruding breast of a chicken. It is usually present since childhood, because of rickets or malnutrition, and is of little importance in adult years.

Funnel Chest. A common deformity which is the opposite of pigeon breast. The chest wall has a pushed-in appearance due to the breast bone being pulled back against the spine by muscles and ligaments. Funnel chest may interfere with proper heart and lung action in childhood, but in later years seems to cause very little difficulty.

Fig. 38. Emphysema may produce barrel-chest deformity. The chest must be constantly overexpanded to compensate for a thinned-out and less effective lung.

Emphysema (Barrel Chest). This enlarged chest is actually a constantly over-expanded chest. The disease consists of thinned out lung tissue, with the chest over expanding in an attempt to better use the remaining lung. This is a debilitating disease confined to later age groups. (See Lung Disease).

Lateral Curvature of the Spine (Scoliosis). Curvature of the spine is very common in later years and is possibly the result of childhood rickets, mild poliomyelitis, or foot and leg difficulties.

Work habits also can produce a mild degree of curvature of the spine, but usually lateral curvatures are not even suspected until the deformity is accidentally found in an examination. Seldom do they cause any difficulty. (See Deformities of the Spine.)

Examination of the Female Chest

1. Stand before the mirror in the usual erect position, with all clothing removed above the waist. Note any difference of the breast in size, shape or position and closely inspect the nipple for possible inversion.

2. Raise both arms straight overhead and lean slightly forward. Note in the mirror any denting or bulging irregularity of the skin surface. Look especially for skin areas of “Peau-D-Orange,” a finely dimpled orange-like skin.

3. In lying-down position, elevate the left shoulder blade on a pillow and rest the left arm under the head. With the right hand, feel along radial (wagonwheel spoke) lines, the inner half and then the outer half of the breast. Note any solitary enlargements, lumps or masses.

4. Now place the left arm at the side and again feel along radial lines, the outer and then the inner half of the breast. The normal, rubbery soft breast tissue may have an all-over granular feeling, but nodules, lumps or soreness are definitely abnormal findings.

The chest

The chest is a cage of breastbone, ribs and vertebrae, covered with muscles, ligaments and skin. In its external aspect, the chest includes the breasts, ribs, breastbone and upper spine, while internally it houses and protects the heart, lungs and esophagus.

Examination of the External Chest

Stand unclothed to the waist before a full-length mirror, breathe normally and make the following observations:

1. The breastbone has a bony ridge two inches from its top, called the sternal angle, but is otherwise flat from top to bottom where the ribs join. A small tender bone called the “ziphoid process,” can be felt here. Deformities may result
in pigeon breast, funnel chest or emphysema.
2. The rib cage is somewhat bell-shaped, and breathing should produce painless and equal rib motion on both
sides. Limited or painful motion on one side may mean lung diseases, such as tuberculosis, lung abscess, bronchi-
ectasis, pneumonia, pleurisy, or disease of the rib joint itself- Tietze’s Syndrome.
3. In right-handed people, the right shoulder is lower than the left, but a great difference in shoulder level may mean curvature of the spine.
4. With the fingertips, press tightly against the ribs along the sides of the breastbone; painful spots in this region may indicate Tietze’s Syndrome, a form of arthritis. *

Fig. 33. The chest is a most vital region. The breast, heart, lungs, giant blood vessels, rib cage and swallowing tube may cause difficulties here. Disease in this region is hard to hide because pain and other symptoms are noticeable early.

Thyroid disease is seldom seen today, but thirty years ago it was a common sight to

see large neck goitres. Medical research found that iodine was lacking in the soil in regions where thyroid disease was prevalent and the addition of iodine to table salt in these regions, resulted in a sharp drop in disease of this gland. Few people realize the importance of the commonplace box of iodized table salt, but this discovery has benefited thousands of people. The diseases of the thyroid encountered today are most frequently seen in the over-fifty age group.

Enlargement of the Thyroid Gland {Goitre). Any enlargement of the thyroid gland is significant because this gland embraces the windpipe and is firmly attached to it. The enlargement may compress the windpipe to create difficulty in breathing and sometimes in swallowing. A smooth balloon-like enlargement, usually in young women in otherwise perfect health, is the “colloid” goitre, which results from insufficient iodine in the diet. Medical treatment, in the form of iodine therapy, is usually followed by a reduction in the size of the thyroid gland.

A bumpy, nodular grape-like enlargement is a goitre, possibly of the over-functioning type. These thyroids are very likely to create considerable systemic difficulty in the present or future, and therefore, are candidates for medical or surgical treatment. Cancer of the thyroid gland, usually felt as a single bump or nodule, is not common, but any solitary lump felt in the thyroid region, demands the examination and diagnosis of a doctor skilled in this field, as treatment may be necessary quickly.

Over-Active Thyroid (hyperthyroidism). Thyroid over-activity is often the cause of nervousness and weight loss. The gland is not necessarily enlarged but it produces definite symptoms of over-activity, such as, loss of weight, extreme nervousness, tremors of the fingers, excessive perspiration and palpitation of the heart. Over-activity of the thyroid may be treated either by medication, surgery, or x-ray. It is only after adequate examination that the course of best treatment can be known.

Under-Active Thyroid (hypothyroidism). A thyroid gland with too feeble a function is soon reflected throughout the body in several ways. There is a weight gain without any apparent over-eating, long sleep with persistent fatigue and often a dry skin with dull unmanageable hair.

The thyroid gland is the fire-and-ambition gland of the body, and without it nearly all drive is lost. Treatment of an under-active thyroid is simple. It is thyroid hormone, taken orally, under the guidance of the physician for the cure of this health and ambition stealing disease.