On the Second Day

On the Second Day, you will receive radiological, cardiological, dermatological, and various endoscopic exams. You will refrain from eating and drinking, and take a shower in order to clean your skin (please do not apply any lotion or skincare product, as required by dermatological specialists). You should only dress in your hospital gown. You may put on a pair of clean panties, but you should not wear a bra, as wearing one will obstruct the streamline of different exams. The nurse will fetch you from your ward at 7:30 and take you to the radiology department, located on the second floor

Radiology (one hour)

At the radiology lab, you will receive a chest and abdominal x-ray checkup. The purpose is to provide the medical team a general knowledge of your lung, heart conditions, as well as to detect rib fractures and any underlying injuries in your chest and abdomen. The technician will direct you on how to position and reasonably expose your body. Pictures will be taken from both standing and supine position.

You will be instructed to stand close with your chest and abdomen against the detector; the technician will also ask you to take some deep breaths

Then, you will be instructed to lay down with your face up on the exam table and repeat the exam

CT Scan

A CT scan is designed to acquire a set of more comprehensive images of you internal organs, including your brain, difference glands, heart, kidney, intestine, and bone structures.

You will be asked to completely disrobe, including your panties, and lay on the exam table, which will slowly move through the detect ring; you should also wear the headset provided, as it will cancel noise made by the machine

After the exam, you will be offered a light breakfast. After breakfast, you will be taken to the cardiology lab on the third floor.

Cardiology (two and half hour)

At the cardiology lab, a rest 18-lead Electrocardiogram (ECG) will be taken and various stress ECG tests will be done to assess your cardiovascular functions. A echocardiography (heart ultrasound) and arterial doppler test will also be used to further investigate the conditions by visualizing your heart rhythm.

You will be instructed to completely disrobe and lay down on the examination table. The nurse will measure your blood pressure and conduct a brief auscultation of your chest to determine your state of relaxation

Once determined by the medical team that you are properly relaxed, the nurse will proceed to wipe down your chest, ankles, and wrists with sterilizing solution. Similar to 12-lead ECG, an 18-lead ECG is used to measure the rhythm of your heart and any defects in your cardiovascular functions. A total of 18 adhesive electrodes will be placed, with ten on both left and right chest, four on each end of your limbs, and four more on your lower abdomen and shoulders near your collarbone. A breathing monitor around your chest will simultaneously be used to measure your chest expansion during inhale-exhale cycles and a blood pressure cuff applied as well

The rest ECG exam will take around 20 minutes and it is absolutely essential for you to remain relaxed

Treadmill and Stationary Bike Stress Test

After the rest ECG exam, you will be instructed to exercise on a treadmill and a stationary bike in order to put your cardiovascular system under some physical stress. The nurse will bring a sports bra and a pair of training shoes for you. You should put on your sports bra, panties, and shoes. Please also be aware you should put on your bra over the ECG leads. On the treadmill, you will do the following:

15-minute walking

15-minute jogging

5-minute sprinting

After the treadmill, you will be helped off the treadmill and sit down on the exam table, where the medical team will measure your blood pressure, blood oxygen level, and perform a brief cardiac exam. You will be given 5 minutes to rest before starting on the stationary bike

10-minute exercise at normal speed

10-minute exercise at accelerated speed.

Cardiac, arterial ultrasound, and Transesophageal Echocardiogram (optional, takes around one to one and a half hour)

After the stress test, the nurse will remove the electrodes from your body and give you a towel to dry up yourself. When peeling off the electrodes, there will be some red marks on your skin. There is nothing for you to worry about as the marks will disappear shortly. You will be asked to completely remove your clothes again and lay down on the exam table. The technician will place a 3-lead heart monitor on your body and start the exam with both your general practitioner and cardiologist observing:

The technician will use a transducer (probe) against your chest and move it around to capture different images of your heart valves and blood floor.

You will be instructed to switch position from supine to lateral as needed

Along with the echocardiography, the technician will also scan major arteries to rule out Peripheral Arterial Disease (PAD). Typical areas that technician will apply transducer are neck, upper and lower abdomen (including your groin area), and lower extremities.

Transesophageal Echocardiogram (TEE): if deemed as needed, the cardiologist will request transesophageal echocardiogram to be done. You will be given a mild oral sedative on your throat. Following this, a special transducer will be inserted into your esophagus, which will provide a highly-detailed image of your heart. You will need to remain absolute relaxed, as movement will cause esophageal perforation, hemorrhage, and other life-threatening injury. Since this is a minimally-invasive procedure, we will only conduct it if necessary.

Dermatology (one and half hours)

After the conclusion of cardiac exam, you will be taken to the dermatology lab for a full-body skin exam and systematic allergy test. All clothes should be off in the lab.

The dermatologist will use a dermatoscope to systematically exam your skin, paying close attention to your breasts and genitalia

Allergy test: the dermatologist will use a combination of prick, patch, and intradermal methods to assess allergic reaction. Patch test will be mostly used and patches contain small amount of allergen will be applied on your arms, abdomen, and lower extremities. Prick tests will only be used on your breasts and nipples, as they are intended for small areas. Small amount of allergan will be applied and the skins will be gently pricked to allow allergens to penetrate. Intradermal injection will be used on your genitalia area, as allergens will be injected through a small needle under your skin

Allergic reaction will typically be revealed after one hour

A set of photos will be taken for further evaluation

This will conclude the exams in the morning. You should take a shower to clean your body and refrain from eating

Endoscopic and Urological Exam (three hours)

In the afternoon, you will be taken to the endoscopy lab for a various tests. Below are what you should know

Preparation: you will be required to change into a special gown and expose your lower body. The nurse will sterilize your genitalia with clean A set of enema will be administered to clear your intestine and colon and douching used to clean your vagina.

Anoscopy, proctoscopy, and colonoscopy: you should lay on your right side with your buttocks facing the technician. First, a short endoscopic scope will be inserted into your rectum to inspect your lining of your lower rectum and anus to check for signs of injury or disease. Following anoscopy, a medium sized scope will be inserted for proctoscopy, which will go further into your rectum and generate better visuals. Finally, a long, flexible scope will be inserted back into your rectum and advanced into your colon to inspect the lining of your colon. A biopsy sample may be taken per the doctor's instructions.

Vaginoscopy: you will be asked to switch to supine position and place your feet onto the stirrup. A speculum will be used to open your vaginal opening and a scope will be inserted through the speculum to examine your vaginal canal, cervix, and lower parts of uterus for screening inflammatory disease and assessing developmental stages. You will feel slight pressure and discomfort when the scope penetrates your cervix

Urodynamic and Cystoscopy: You will be undergoing urodynamic testing and cystoscopy to assess your bladder function and urinary tract. During the urodynamic test, a small catheter will be inserted through your urethra into your bladder to measure pressure and urine flow. The cystoscopy involves using a flexible camera to examine the inside of your bladder and urethra. These procedures may cause mild discomfort, but they are generally well tolerated and take about one hour. The total time of the procedures will take around half an hour.

This concludes your second day at the Well Women Clinic.