Internal Medicine — Town Hospital

Internal Medicine at Town Hospital: an overview

Town Hospital's Internal Medicine department in the Fifth Settlement, New Cairo, diagnoses and manages medical conditions that do not belong to any one organ specialty, and it is the first port of call for many of them: diabetes and high blood pressure, thyroid disorders, anaemia, fever and infections, chest conditions and joint pain, as well as general symptoms such as persistent tiredness or unexplained weight change. The department's doctors cover general internal medicine, endocrinology, liver and digestive disease with endoscopy, infectious diseases, and chest and rheumatic disease; you will find them in the list of doctors below.

What an internist needs to reach a diagnosis is available in the hospital: a laboratory open 24 hours a day for the full blood count, liver and kidney function, blood sugar, hormones, thyroid tests, tumour markers and viral tests; a radiology department open 24 hours a day with a 3 Tesla MRI, a 128-slice CT scanner and ultrasound; an emergency department open 24 hours a day; an intensive care unit for the patients who need it; and a day-care unit for treatments that need a few hours of observation without an overnight stay. The outpatient clinics are open every day from 10 am to 10 pm; each doctor's clinic days and times differ and are shown in the up-to-date clinic schedule.

Conditions the department looks after

The diagnosis and the choice of treatment remain the doctor's decision after the consultation and tests. These are the conditions patients most often come to the department with.

Diabetes

Diabetes is a long-term rise in blood sugar. Type 1 usually starts young and needs insulin from the outset; type 2 is far more common and is linked to weight, lifestyle and family history; and gestational diabetes appears during pregnancy and needs its own follow-up. It is diagnosed with a fasting blood sugar or with the HbA1c test, which reflects the average sugar level over the previous three months. Treatment rests on diet, physical activity and weight loss, together with the various classes of sugar-lowering tablets or insulin, depending on the type and the case; the doctor chooses the class and adjusts it at follow-up. Because diabetes affects the eyes, kidneys, nerves, heart and feet over time, regular follow-up includes the HbA1c, kidney function and urine protein, blood fats, blood pressure, a foot check, and a retinal examination to which you are referred.

High blood pressure

High blood pressure usually causes no symptoms, yet over the years it strains the heart, kidneys, brain and eyes, which is why it is found by regular measurement rather than by how you feel. The doctor confirms the diagnosis with repeated readings at different times and requests tests that look for its effect on the kidneys and heart, and for the rare causes that can be treated. Treatment starts with less salt, physical activity, weight control and stopping smoking, with blood-pressure medicines whose class the doctor chooses according to your age and other illnesses, sometimes combining more than one class. Do not stop the medicine once the readings settle: a normal reading is the medicine working, not a sign the condition has gone. When the main complaint is the heart itself, such as chest pain or palpitations, the department works with the Cardiology department.

Thyroid disorders

The thyroid is a small gland at the front of the neck that sets the pace of the body. When it is overactive, you may lose weight despite a good appetite and have palpitations, anxiety, sweating, trembling hands and, in women, irregular periods; when it is underactive, you may feel tired and cold, gain weight, and have dry skin, constipation and hair loss. The disorder is diagnosed with a blood test of the thyroid-stimulating hormone and the thyroid hormones themselves; the doctor may add thyroid antibody tests or an ultrasound scan of the gland if it is enlarged or has nodules. An underactive thyroid is treated by replacing the missing hormone at a dose the doctor adjusts by blood tests; an overactive thyroid is treated with medicines that reduce hormone production, and the doctor discusses the other options when they are needed, including surgery, which is done by the General Surgery department. Follow-up is with the internist or the endocrinologist.

Anaemia, including thalassaemia

Anaemia is a shortage of haemoglobin, the part of the blood that carries oxygen, and it shows as tiredness, a pale complexion, breathlessness on exertion and dizziness. The most common cause is iron deficiency, from diet, heavy periods or hidden bleeding in the digestive tract; vitamin B12 and folate deficiency and long-term illness are other causes. Assessment starts with a full blood count, iron stores and vitamin levels, and the cause is treated, not just the number: replacing the missing iron or vitamin, and looking for the source of any bleeding. Thalassaemia (Mediterranean anaemia) is different: an inherited fault in the make-up of haemoglobin itself. A carrier has a mild anaemia that looks like iron deficiency but does not improve with iron, so the two are told apart with a test that separates the types of haemoglobin before any iron treatment is started, and couples with a family history are advised to be tested before marriage. Severe forms need specialist follow-up, which the doctor arranges.

Fever, infections and viral hepatitis

A fever that lasts for days without an obvious cause, or keeps coming back, needs an assessment that looks for the source of infection: the chest, the urinary tract, the digestive system or a viral illness. Diagnosis relies on the consultation, the full blood count, inflammation markers, cultures and viral tests, with imaging when needed. Bacterial infections are treated with antibiotics the doctor chooses according to the site of the infection and the culture result; never take them on your own, because careless use makes them stop working. The department includes a consultant in infectious diseases and liver disease, who follows hepatitis B and C with viral tests, liver function tests and ultrasound, decides on antiviral treatment and its duration according to the case, and also follows patients with hepatitis A.

Chest conditions and rheumatic joint pain

The department follows asthma, chest allergy, chronic bronchitis and pneumonia; diagnosis relies on the consultation, a chest X-ray and blood tests, and treatment includes inhalers that open the airways and reduce inflammation, antibiotics when there is an infection, and stopping smoking. It also looks after painful, swollen or stiff joints, telling wear-and-tear arthritis apart from immune rheumatic diseases such as rheumatoid arthritis and gout, with immune blood tests, inflammation markers, uric acid and imaging. Treatment of rheumatic disease includes painkillers, anti-inflammatory medicines and the disease-modifying medicines that need regular blood-test monitoring. Joint injuries and fractures belong to the Orthopaedics department.

Digestive complaints

An internist can assess many simple digestive complaints, such as heartburn, bloating and indigestion, and request the first tests. H. pylori (the stomach germ) and its treatment, persistent acid reflux, gastritis, irritable bowel syndrome, fatty liver, and gastroscopy or colonoscopy are covered on the Gastroenterology & Endoscopy page, and you are referred there when needed.

Kidney function: checks and referral

Diabetes and high blood pressure are the two most common causes of weakened kidneys, so the department checks kidney function (creatinine and urea) and urine protein regularly in patients with either condition, follows recurrent urinary tract infections, and looks for the cause of any abnormal result. When tests show a persistent fall in kidney function, the doctor decides the next step and refers you to a kidney specialist for ongoing care.

Tests in the hospital

• Blood tests: the full blood count, liver and kidney function, fasting sugar and HbA1c, blood fats, hormones and thyroid tests, tumour markers and viral tests, in a laboratory open 24 hours a day that takes walk-ins at any hour.
• Urine tests and cultures: to diagnose urinary tract infections and identify the right antibiotic, and to measure urine protein in patients with diabetes or high blood pressure.
• Imaging: chest X-ray, ultrasound of the abdomen and thyroid, 128-slice CT and 3 Tesla MRI, in a radiology department open 24 hours a day.
• ECG: as part of the assessment of patients with high blood pressure or diabetes when needed, with the Cardiology department.

You will find these tests on the Diagnostics page. When a condition needs admission, such as a severe rise in blood sugar or an infection that needs intravenous treatment, the internist looks after you on the ward or in the intensive care unit, depending on the case.

When you need emergency care straight away

Call an ambulance or go to the nearest emergency department straight away for:

• Pressing chest pain, or sudden severe breathlessness.
• A very high blood sugar with vomiting, confusion or marked drowsiness, or a low blood sugar that does not improve with sugar or comes with loss of consciousness.
• A high fever with a stiff neck, a severe headache, a rash or confusion.
• A very high blood pressure reading with a severe headache, disturbed vision or chest pain.
• Sudden weakness on one side of the body, or a sudden change in speech.
• Vomiting blood or passing black stools, or yellowing of the skin and eyes with a fever or confusion.

Town Hospital's emergency department is open 24 hours a day. It does not receive digestive (GI) bleeding, so for that call an ambulance directly.

Your care, step by step

• Consultation: the doctor asks about your symptoms and how long you have had them, your long-term conditions, current medicines and family history, reviews any previous results, measures your blood pressure and weight and examines you.
• Tests: the blood tests and imaging your case needs, and no more, done in the hospital, on the same day where the type of test allows.
• Decision: the doctor explains the diagnosis and the treatment options, from lifestyle changes to medicines, the decision is made together with you, and you are referred to a sub-specialty when the condition calls for it.
• Treatment: usually in the clinic, and in the day-care unit or on the ward when treatment has to be given through a vein or needs observation.
• Follow-up: regular appointments at an interval the doctor sets according to how stable the condition is, with follow-up tests; never stop a medicine or change its dose on your own.

The hospital is contracted with more than 40 payers, including insurance companies, professional syndicates and government bodies, and cover depends on the payer and the terms of the contract.