Year End Casualty

>> Wednesday, December 31, 2008

Today marks my the last day of my ER rotation and I m happy that I can spend the coming of the new year here at home.

This afternoon in the few hours remaining in my ER rotation, one of the ambulance drivers noted a vehicular accident a couple of streets away from the hospital. The ER consultant then advise the patient to be picked up and brought to the hospital. So the ambulance made a quick rendezvous at the hospital grabbed some equipment and then went directly to the accident site. After a few minutes, I was sitting at the front desk when the ambulance arrived back at the hospital, I went out to meet them and the victim that came out of the ambulance shocked me. It was a street child around 9 to 10 years old, his face covered with blood. We then rushed him to the critical area and upon placing of the chest electrode the patient was already flatline. The patient's face was covered with his own blood, and the smell was really not that pleasant. Poor child not being able to meet and greet the coming new year. Hopefully tonight as I m at home no serious injuries even deaths are currently happening at the hospital and hopefully everyone will be healthy in greeting the new year. As we face another year in our lives, may our lives be healthy and blessed. Pleasant Day and a Prosperous New Year.


Clearing Acne In A Zap

>> Saturday, December 27, 2008

Acne has been one of the most if not the most irritating skin growths faced by mankind. Aside from the stinging sensation it gives on your face, it could also leave a mark on your face that could lower your self esteem and somehow make your face not that appreciated.

In the Dermatological world, tons and tons of acne treatments have already been produced but not all leave up to their name. Murad Acne has been made to clear that irritating acne for good and leave you with a flawless and shining brand new face. Its an acne treatment that won't leave a mark on your face. Its easy to apply and you could see results in 4 weeks.

The Acne Complex has work wonders even for those acne that are difficult to treat. It has work miracles among people with acne from different age groups and from different skin types. People everywhere are reporting in results on how their acne are cleared in a short span of time. So why wait and suffer from any acne problems, Murad Acne Complex can give you the results you've always wanted, simple and fast.


Faces Of Death

>> Sunday, December 21, 2008

Last night's tour of duty was not that of a hustle except for a few surgical patients. But around 4:30 to 5:30 in the morning, I saw two people die in front of me. One died in the ICU while the other one died at the ER.

Around 4:30 in the morning, when I was about to sleep in one of the ER beds, a page was being sent by the operator saying a code 99 occurred in one of the rooms in the 4th floor. After the page, I stand up went upstairs with one of my ER residents. Upon arrival at the room, residents from the internal medicine department were already there. Patient was then transferred to ICU, while in the ICU patient suffered a cardiac arrest and I did CPR on the patient on alternates with another doctor. Eventually after 30 minutes of resuscitation, the patient eventually expired.

While resuscitation was ongoing at the ICU, one of the ER nurses called telling us that a patient arrive at the ER arrested. So after the patient expired at the ER, I went down right away at the ER to take a look at the situation. Resuscitation at the ER was on going and eventually after another 10 minutes the patient was declared dead. It was somehow gloomy to see to people die in front of you. After 2 hours, I ate breakfast then we had our morning endorsements and I was homeward bound. Pleasant Day


A Sleepless ER Duty

>> Friday, December 19, 2008

My 1st ER duty wasn't the ER duty that I expected nor wanted. Since morning up to dawn of the next day, ER patients were coming in like there was no end. Most of the patients coming in the ER were due to trauma or a vehicular accident. We had 1 casualty in the ER due to aspiration pneumonia. Aside from the complicated cases, opd cases also came in from morning to dawn. I was expecting that by around 1 in the morning I could get some sleep but unfortunately what I expected didn't happen. Insted of expecting to get sleep, I didn't get any, I only got a shallow closing of the eyes for less than 30 minutes I guess.

I was somewhat awake until 8 in the moring when we had our moring endorsements of the patients that were left from the night. After endorsements and once our relievers are already there, I went straight to the 4th floor to get some valuable and much needed sleep. I got around 2 hours of sleep before I went home.

Tomorrow marks another tour of duty at the ER, hopefully sleep won't be that elusive as what happen in my first duty. Pleasant Day


Day 1 - Emergency Room Rotation

>> Tuesday, December 16, 2008

Yesterday was my last day in my Surgery rotation, and as I moved on, today marks my first day as an emergency room rotator.

My first day in ER today was not quite remarkable, saw only a few patients most of which came in due to an elevated blood pressure. Nothing unusual happen in my day 1 rotation. Tomorrow marks my first tour of duty in the ER, hopefully nothing out of the blue happens.

In our ER setting, some patients usually seek consult due to fever, cough and some midnight workers just want to seek consult in order to get a medical certificate to excuse them from not going to work. Being in the Emergency room, we are the first line in dealing with patients, stabilize them if the have unstable vital signs and then referring them afterwards to the specific department. Its quite enjoyable when staying in the ER but sometimes it gets to tiring when a lot a patients come in and out of the ER door. As I face my first tour of duty tomorrow, hopefully ill make it through intact. Pleasant Day


Sunday Medical Mission

>> Sunday, December 14, 2008

This morning, I went to Cavite City (a local province) to joined a medical mission. I hold this medical mission near to my heart because I ve always attended this medical mission every December in the past couple of years. So again for this year, I was again their to attend the said medical mission.

We arrive at the site at around 9 in the morning, and before starting breakfast was serve among us. After breakfast we then started and divided ourselves into groups, one group was for adult patients, the other was for pediatric patients and another group was assigned for the local day care students. I was assigned to the pedia group and I thinked I saw about 100 patients for the whole day. The medical mission ended at around 3 in the afternoon and gifts were given to us by the sponsors. After having a brief merianda, all of us were homeward bound and as early as now, I m looking forward to next year's medical mission and hopefully my schedule next year would allow me to join again the said medical mission. Pleasant Day.


Report Annoying Phone Calls

>> Thursday, December 11, 2008

Have you ever receive an annoying phone call just to find out that the other person was dialing a wrong number? How you ever had a phone call telling you you won something like money or property but after all the good stuff it was a scam?

The above mentioned experiences are just some calls that you want to avoid or try not take for they just waste your time. How about a site where you can report numbers on your caller ID and tell other people that those numbers are scam or they just tell you non-sense.

At Phone Number Reporting, you can report your experiences with different phone numbers and tell other people what to expect when they get a call from the said number. It could be a scam, a sales call or anything. At least when the people already know what to expect, they won't be surprised and would know what to do. So visit Phone Number Reporting and start reporting those numbers and you could also read reports from other people


Avulsed Thumb

>> Tuesday, December 9, 2008

Another tour of duty ended, yesterday's tour of duty wasn't that of a hustle. We only had 2 admissions and 3 referrals for the department of Surgery. One admission was a 3 year old boy who accidentally closed a metal gate and trap his thumb in between and the result was an avulsed thumb.

Repair was supposed to be done at the ER unfortunately the patient won't cooperate. Screaming every time we try to clean his wound. So my resident decided to admit the patient and do it under sedation so the crying and screaming would stop. He was eventually admitted and was eventually scheduled the next day.

Young kids shouldn't be left out playing by themselves because they usually end up hurting themselves and end up in the emergency room. Keep a good eye on your kids when they play, things can get nasty if no one is around to watch them. Pleasant Day


Two Cases of Breast Cancer

>> Sunday, December 7, 2008

In my last tour of duty, we admitted 2 cases of breast cancer and both were scheduled to have a modified radical mastectomy the next day. The first one was in her early 50's while the other one is in her late 40's. Both of them noted a mass while doing the breast inspection.

In my earlier posts, I think around 2 months ago, I ve mentioned the importance of doing a routine breast examination. It s cheap and easily done at the leisure of your time, and it doesn't need an expert to detect if you have any abnormalities in your breast. The first patient, already had 3 excision biopsies done on her breast, the first 2 yielded benign results however the 3rd one was malignant. For the other one, she noted a mass on left breast and at first did not paid attention, however she noted the mass was rapidly growing, and an incision biopsy was done which showed an invasive ductal carcinoma.

Mastectomy was done the next day to both of them by two different attending surgeons. Hopefully after the surgery they would be cancer free. This two patients somehow points to the importance of self breast examination, with early detection of cancer, you could always go for cure. Pleasant Day.


Research Presentation

>> Thursday, December 4, 2008

Yesterday, as what I ve mentioned in my previous post that it was a contest of interesting cases but for today the senior residents were the one on the spotlight as they presented their different research papers for a good and educating contest.

As again I cheered for my surgery resident who showed a paper regarding prognostic scoring among patients who complain of right lower quadrant pain and who among them have appendicitis. His paper was great as it showed different scoring components which could aide the clinician in diagnosing acute appendicitis and when is the appropriate time to operate on the patient. Aside from that his paper also showed components on how to know if the appendicitis is a complicated one or not. All in all he presented a good paper. Unfortunately when the announcement of winners came, 1st place went to the department of Pediatrics for a study among children 6-12 years old who are obese at a certain public school. Anyways all who presented were winners in their own right because they all gave it time and effort. Looking forward to next year's competition. Pleasant Day


Interesting Case Presentation

>> Wednesday, December 3, 2008

This morning, I attended at the health tower near the hospital an interesting case presentation among the residents of the different clinical departments of the hospital. Since I m currently in Surgery, I went there cheering for my surgery resident, but all of us are pals at the hospital.

Each resident was allotted a total of 8 minutes to present their case and a question and answer portion came afterwards. My resident presented a case of anal marginal carcinoma are rare type of cancer which has a frequency of 7 in a million among males and 9 in a million among females. The case presentation was great and cheers came from the crowd. Other department residents also presented different interesting cases in their field of practice. The whole event lasted the whole morning and awards were given afterwards to the winners.

It is a good thing to see some friends competition among residents especially when promoting some diseases. Pleasant Day


5.11 Tactical Pants - Pants That Lasts

>> Monday, December 1, 2008

People now a days usually were pants as their normal ordinary attire when they go out or when they just simply hang out with friends. Some pants usually gets easily worn out or sometimes gets torn easily. How about getting pants that are known to last and its makers are in the pants business for a long 30 years? Pants that have been used by the Law Enforcement team may it be federal, state or local.

5.11 Tactical Pants is in the business of making pants for use in federal, state or local Law Enforcement. They have a 30-year old history of making durable pants for our Law Enforcement people. Their pants are uniquely made for law enforcement people and have stood the test of time. Their pants can survive the rugged endeavors associated with training and missions of our law enforcement people. They also have a jumpsuit made and a fire resistant one which are heavy duty and could live up to its name. Aside from the pants, they have also made working boots to matched with the different pants they offer. The boots they offer can be use for heavy outdoor activity or simply having leisure with friends.

Although they have made pants for law enforcement, their pants could easily fit in among ordinary people. The different khakis they make can easily be used with great comfort for gatherings, activities or simply using it when taking a stroll at the mall. So why settle for pants that could easily be worn out, try 5.11 Tactical Pants for your pants' needs and you won't regret having this pants. So why wait, revolutionize your pants experience now and visit 5.11 Tactical Pants and you won't regret it.


An Emergency Exploratory Laparotomy

>> Sunday, November 30, 2008

Yesterday we had a stat exploratory laparotomy on one of the in patients who underwent an elective "Ex-Lap" for a take down colostomy around 4 to 5 days ago. She was a high risk patient because around 2 to 3 days post operatively she suffered a myocardial infarction at the wards. She was then eventually transferred to the ICU.

The reason for the stat exploratory laparotomy was she was noted to have a wound dehiscense and aside from that her bowels were noted to be dilated. She was then brought to the OR for the procedure. Upon opening her up, I noted her bowels to be really dilated from the small intestine down to the large intestine. Adhesions were noted all over the place. Eventually decompression was done and closure of the wound dehiscense was done. After the operation she was eventually brought back to the ICU were close monitoring was done. This morning prior to me going home, I passed by the ICU to check his condition, she was eventually awake and would just communicate by nodding to some of my questions. Hopefully she would improve in the coming days. Pleasant Day


An Emergency Craniotomy

>> Friday, November 28, 2008

This morning I was supposed to be assigned to assist on a cholecystectomy case. Unfortunately I arrive in late, and someone already was put in my place. I went back to our quarters to return my scrubs, one other intern then informed that the was a cranial bleed case in the ER and my residents are already there. So I jumped and went to the ER. Upon reaching the ER, I noted that the patient intubated in the ER was just discharged from the hospital yesterday.

He was a 23 year old male who was previously admitted at our institution due to a vehicular accident around 2 weeks ago. He was hit by a dump truck and was immediately brought to the ER. During his stay at the hospital, he underwent a craniostomy due to a bleed in his brain. Yesterday, he was doing ok with stable vital signs and was already discharged. Unfortunately around 2 in the morning, according to his relatives, he started to complain of severe headache and his condition continued to detoriorate and he was immediately rushed to the ER. At the ER, a repeat CT scan was done reveling an intracranial hemorrhage and a stat craniotomy for evacuation of hematoma was done.

I again rushed to our bed quarters and grabbed my scrubs then went directly to the OR. Patient was immediately brought to the OR and his brain was cut opened. Intraoperatively around 5 to 6 big clots were noted on the right side of his brain and was immediately removed. A part of his skull was removed and was scheduled to placed again some other time to relieve brain pressure. After the operation he was then admitted to the ICU. Hopefully his status will improve in the coming days. Pleasant Day.

The CT scan above was somewhat the same as the repeat CT scan of the patient mentioned above.


Infected BIG Toe

>> Tuesday, November 25, 2008

I m assigned to the OPD today since I m just on pre duty status. We only met a couple of patients, most were follow ups. I grabed one folder and the chief complaint labeled as swelling of the big toe. Then I called out on the patient, then there was this little boy who went towards me. Then I asked the parent what happened, she said the a week ago, her child accidentally stepped on a broken piece of glass which caused a puncture wound on his right big toe.

Unfortunately, after being punctured the boy was not brought to a hospital for tetanus shots and a simple cleaning of the wound was done. Yesterday, according to the mother, the big toe started to swell and started to turn red. Pain was also noted upon touching the affected part. Upon careful examination, a pus was already noted aroung the wound site. Incision and drainage was then advised to the patient which the patient, crying, complied. A 2 cm incision was done which produced outflow of the pus inside. Patient was then prescribed with antibiotics and daily wound care was instructed. He is to come back next week and hopefully his big toe wont be that engorged due to infection so that he can walk straight. So guys be careful of little pieces that causes a break in your skin, who knows they might caught a local inflammation and eventually an infection. Pleasant Day

The picture above was somewhat the replica of the patient's big toe.


Bone Flap Placement

>> Monday, November 24, 2008

Another tour of duty in surgery has ended and we had a total of 4 admissions yesterday. We had a 25 year old male who underwent craniotomy (removal of a part of the skull) 5 weeks ago due to a bleed in the brain secondary to a vehicular accident. He was admitted for placement of the part of the skull which was earlier removed.

When we visited the patient, he was currently eating and was doing ok. No signs of any deficits were noted and he was even speaking well. The only striking part in him is that the right side of his head is somehow deformed due to the absene of a skull part in that region. He is scheduled this afternoon and hopefully by tomorrow when I see him again hopefully his head won't be deformed anymore. Pleasant Day


Mesothelioma - A Deadly Occupational Disease

>> Friday, November 21, 2008

Mesothelioma is a type of cancer which is caused when a person is expose to the chemical asbestos. It affects the mesothelium which is a protective lining of the pleural cavity. People affected or people who harbor this deadly disease are people who work or are exposed to asbestos in their workplace. Symptoms are usually chest pain, shortness of breath and other systemic manifestations. More information regarding mesothelioma can be viewed at Mesothelioma Information

Compensation among workers exposed to asbestos is an important issue in mesothelioma. Families of affected workers should be educated and should be properly instructed on how to file for compensation. Mesothelioma is a group of lawyers dedicated in handling mesothelioma cases. They provide important details not just for mesothelioma cases but also important details on the disease itself. They have a wide range of lawyers for you to choose from in whom you think will best represent you in your case. For a more detailed information visit Mesothelioma


A Morning of Mourning

>> Thursday, November 20, 2008

Prior to ending my last tour of duty in Surgery, we had 2 mortalities. Both of them died at the ICU and both of them almost expired at the same time, maybe just seconds in between.

The first to expire was a 70 year old female who underwent right sided hemicolectomy (removal of the ascending colon) due to a mass. During the previous afternoon, her lung finding were starting to get congested with note of crackles all over the lung field. Patient was intubated in the ward and was eventually transferred to the ICU. She was there the whole night closely monitored, until around 5 in the morning, she arrested. She was initially resuscitated but to no avail and eventually expired after an hour.

The second mortality we had that day was a 9 month old baby boy who suffered from severe pneumonia. He was admitted the night prior and he was referred to our service for CTT (chest tube thoracostomy) insertion due to a pneumothorax. CTT was eventually inserted at the ER and he was also admitted into the ICU. He was also closely monitored through out the night until aroung 5 to 5:30 in the morning his vital signs started to fall. Resuscitation was done but to no avail and was pronounce dead just after a few seconds after the first patient died.

Today I m on duty again and I dont want to see any mortalities today. Hopefully there would be none. Pleasant Day


Fusion Of The Spine

>> Tuesday, November 18, 2008

Yesterday I was assisted in a spinal surgery because of a fracture located at the level of the lumbar spine (L2 - L4). The patient was a 23 year old female who suffered a vehicular accident 3 days ago and she was hit by a car on her hip area. X ray and CT scan done revealing a fracture in the lumbar area of her spine.

Our spine or vertebral column is composed of 5 parts namely the cervical, thoracic, lumbar, sacral and the cocyx. The lumbar area is located just below the level of our navel. For our patient she suffered a burst fracture at that area. The surgery lasted for 2 hourr. After opening the patient, the lumbar spine affected was identified and 4 screws were inserted into the 4 corners then it was connected by a titanium rod and was eventually locked. The screws inserted really looked good on xray. Hopefully the patient will be back being able to do his normal routine activites and forget the nightmare of the accident. Pleasant Day

The above picture is an example of what was done to the patient at yesterday's operation


Appendicitis - An Acute Stomach Pain

>> Saturday, November 15, 2008

Another tour of duty ended and we only had 1 admission yesterday. She was a 28 year old female who came in with a chief complaint of right lower quadrant pain of the abdomen. So I interviewed the patient for her medical history and did a physical exam on her. On palpation of the abdomen, you could really see her face distorted whenever the right lower quadrant part of the abdomen was palpated. She was eventually admitted with and impression of Acute Appendicitis and was scheduled for a stat appendectomy. True enough, the appendix was noted in its suppurative stage upon opening the patient. The operation run smoothly

The appendix is a blind ended tube located in the transition from the small intestine into the large intestine. Apparently the appendix has no function in the body but some sources say that it is a lymphoid organ early in life. For patient's with acute appendicitis the only cure is to go for surgery. Surgery should be done to avoid complications like a ruptured appendix which could contaminate the gastrointestinal tract and create peritonitis.

The patient this morning was all smiles, her abdominal pain remove, maybe she would be out of the hospital by tomorrow. Pleasant Day.


Eroding Your Anal Canal

>> Thursday, November 13, 2008

I just came home from the hospital and from attending a pre-operative case presentation. The case presented was a 65 year old female presenting with a rectovaginal fistula. She was complaining that some feces are passing out of her vagina. She had noted a mass in her anus for quite a long time. On physical inspection her anal canal is really eroded to the point she hasn't any bowel control.

She was eventually admitted at our institution and a 4 quadrant biopsy was done. The biopsy done revealed anal carcinoma. The surgery team is currently preparing the patient for a major operation (abdominopelvic surgery). Hopefully she will improve after surgery. I was looking at the picture of the patient's anal area and it was a major devastation. Just wondering how she was on her daily life, I mean doing her regular things like eating, taking a bath, going to the comfort room etc. It should really be hard for her having an eroded anal canal, even doing the daily routine stuff. Hopefully after surgery life would be better for her.

It was also mentioned that low grade tumors have a good prognosis, that you can sometimes go for cure. Good prognosis is noted if the cancer is detected early and you can even opt for cure if the needed intervention is given early. So if you think you have some not normal symptoms, visit your friendly doctor, you might save a lot of difficulties in the future. Pleasant Day


Stab Wound Patient

>> Wednesday, November 12, 2008

Yesterday we met a sixteen year old male patient who came in due to a stabbed wound on his left flank area. He came in the ER limping in his school uniform with no signs of any blood in his clothing, so I taught he had just another injury probably from playing basketball from school. So I approached him and asked what happen, then he told me, he was stabbed by a kitchen knife. After hearing this, my eyes somewhat enlarged, I told the ER resident that we have a stabbed wound patient and the patient was eventually hooked to IV fluids.

Although he was stabbed, his vital signs were stable, so I started to ask for his history. He came out of his school campus for a break but someone from another school attacked him and stabbed him from the back with a kitchen knife. The assailant was eventually captured and brought to the police authorities. I asked him what prompted the other guy to stabbed him, and he gave me a smile telling me that its because of a girl he was courting. It made me laugh, somehow, people really do crazy things for love.

On physical examination, aside from the stabbed wound, he has a big hematoma surrounding the wound. An xray and ultrasound was done to rule out any injury or bleeding inside. After that, my residents did wound suturing and evacuation and exploration of hematoma. The patient was eventually admitted. Before going home, I check out his chart and noted that he was doing ok with stable vital signs. People really could kill because of love. Pleasant Day.


Crohn's Disease: Your Bowel Is All Inflammed

>> Monday, November 10, 2008

One of the disease which I discussed during my presentation of the colon was the inflammatory bowel disease, Crohn's Disease. Crohn's Disease is an inflammatory disease which can involved any part of your digestive tract from the mouth down to your anus compared to Ulcerative Colitis (another inflammatory disease) which only affects your colon and your rectum.

Crohn's disease is a type of disease which is very nasty and can really make your life hard. This type of disease causes the lining of your digestive tract to be inflammed which could cause you to have severe diarrhea or severe abdominal pain. This involves the whole thickness of the digestive tract unlike the other inflammatory disease which only involves the upper 2 layers. Other symptoms aside from the two mentioned above include weight loss, bloody stool, ulcer formation, and fistula formation.

Currently, medications are targeted on the different symptoms presented by the disease and currently there is no medical cure for the disease. With advances in technology, treatment is targeted on relief of symptoms and usually they could also give life time remissions that people with this disease could continue with their normal life. When presented with the aboved mentioned symptoms, don't hesitate to consult your friendly doctor, who knows you might have the dreaded Crohn's Disease. Pleasant Day.

The above picture in an endoscopic view of a colon with Crohn's Disease.


Poor Baby Got Bleed

>> Sunday, November 9, 2008

Yesterday's tour of duty was somewhat a little benign inspite of the fact that I don't have my clinical clerks. I had a total of 3 admissions with 2 referrals. One of my admissions suffered a ruptured abdominal aneurysm, a stat abdominal aneurysm repair was done, unfortunately during the operation, no blood was available and the patient eventually suffered a cardiac arrest on the operating table and eventually expired.

My last admission was a bouncing 3 year old boy who suffered a lacerated wound on his parieto-occipital area due to a fall. He was playing with his older sister when he slipped and fell hitting the cabinet which cause the laceration. In the ER, he was bleeding profusely at the back of his head. He was for wound suturing unfortunately he was agitated and resisted. Because of this the patient was eventually admitted for wound suturing under IV sedation. Poor baby, aside from being irritable all night, some blood was still gushing out of his lacerated wound at the back of his head.

After this admission, I had a dose of 2 hours of sleep, woke up had breakfast and I am homeward bound again. Pleasant Day.


Pain: The 5th Vital Sign

>> Friday, November 7, 2008

I saw this poster at one of the clinics at the medical arts building saying that pain is the 5th vital sign. It made me smile and told myself there is truth on what the poster says.

When a patient arrives in the ER, vital signs are usually taken and recorded. This includes blood pressure, temperature, cardiac rate, and respiratory rate. One can add pain to this 4 signs. In my current rotation which is Surgery, we receive ER referrals regarding patients suffering from abdominal pain. They usually want it evaluated by the Surgery resident before sending someone home. In dealing with a patient presenting with abdominal pain, pain is the most significant guide on whether you would operate on the patient immediately or you can still have room for observation. Usually, patients are recommended to be admitted for the sake of observing if the pain would progress or if it would resolve on its own.

Whether dealing with acute appendicitis, cholecystitis or other pain causing conditions, aside from the 4 vital signs mentioned above, one can add the vital sign “Pain” to be included in one’s monitoring of a patient.


Milking the Colon

>> Wednesday, November 5, 2008

We have another patient for daily colonic irrigation. He is a 4 year old likely to have Hirschsprung's disease. The attending ordered daily colonic irrigation prior to his rectal biopsy by tomorrow. The irrigation was done prior to lunch and it somewhat took away my appetite, seeing all those feces go out of a red tube.

Hirschspurng's disease is a condition wherein ones colon or large intestine is devoid of ganglion cells (a type of nerve cell). The patient would usually present with chronic constipation and their bellies eventually enlarged. The stools stored in the colon don't move towardd the anal canal because the colon is not doing its peristalsis thing because its devoid of the above mentioned cells. That's why sometimes you have to do manual evacuation of the feces to relieve symptoms

Hopefully his rectal biopsy tomorrow would turn out to be negative so no surgical intervention may be needed. Hirschsprung's Diseas is a congential condition which is needed to be address as soon as possible. Pleasant Day.

The above picture shows that patient's with Hirschsprung, usually present with a bloated abdomen due to accumulation of feces.


Colorectal Carcinoma – Bowel Habits Won’t Be The Same Again

>> Tuesday, November 4, 2008

Currently in my rotation in the department of Surgery, I was assigned by a surgery consultant to do a report on the topic of Colon, Rectum and the Anus. Actually I already presented half of my report. Now let’s take a look at the malignancy which involves the topic assign to me.

Colorectal Carcinoma is the most common malignancy of the gastrointestinal tract. The incidence among men and women has stayed the same over the past 20 years. Early detection along with improvements in medical and surgical care are thought to be responsible for the decreasing mortality of colorectal cancer observed in recent years.

Symptoms of the above carcinoma usually includes abdominal pain, pelvic pain, anorectal pain (painful bowel movement), fecal incontinence, constipation, diarrhea and lower gastrointestinal bleeding which usually present as black tarry stools. With persistence of the above mentioned symptoms, one should usually seek consult and undergo different screening modalities to be able to catch any disease entity early especially if it is cancer. Risk factors for having colorectal carcinoma includes aging (risk increases among those 50 years and above), history in the family, dietary habits (people who eat less fiber or those having a diet high in saturated fats), environmental (exposure to any carcinogens), inflammatory bowel disease and smoking. If one is a high risk candidate don’t hesitate to seek consult just to be sure your ok.

Treatment for the above carcinoma both includes surgical and medical therapies. Treatment usually depends on what stage the carcinoma is. After undergoing treatment, surveillance is highly recommended to detect early recurrence at the same time surveillance is also highly recommended among people who are high risk for having the disease. You could always go for cure when you catch cancer early. Pleasant Day.


Another Lacerated Wound

>> Monday, November 3, 2008

Yesterday, I again met up with a drunk patient who suffered a lacerated wound. He was evenutally on his way to be when he slipped causing to fall down and extend his arm which then hit a the glass door of the their cabinet. The hit caused a lacerated wound around 6 cm in length and around 2 cm in width. Whew this is much bigger than the previous lacerated wound I encountered at the ER.

Suturing materials where prepared, the wound was cleaned and eventually I did suturing. Aside from the big lacerated wound, there was anohter one around 1 cm in lenght just below the above mentioned wound. I gave it one bite of suture and it eventually closed. The suturing of the wound looked ok and no opening was noted. Hopefully it wont get infected. Drunk people should be a little more careful when they drink the next time, they always end in the hospital if they get clumsy. Pleasant Day

The wound above was somewhat the same as last night's


Incision and Drainage

>> Friday, October 31, 2008

The other day at the out patient department, there was a 10 month old baby suffering from an abscess on his right lower buttocks. After carefully examining the patient, we talked to the mother about the plan for the baby and the mother gave us a go signal to do an incision and drainage. Although at that moment the baby was giggling and was smiling, I was thinking what would he look like after doing the incision and drainage.

After preparing the needed materials for the procedure, I was assigned to hold the baby on his trunk while his mom held him at the head. My resident positioned himself with a scalpel and did a 2 cm incision on the abscess and the cute baby started crying and shouting (poor baby). The mother tried to pacify him but to no avail, after doing the incision, we press on the affected part to let the pus ooze out. After each press, the poor baby cried louder and louder. Finally, the abscess size shrunk and it was over for the poor little boy, antibiotics were prescribed and daily wound care was advsied. Hopefully I could see that baby again next week if he follows up. Just a quick reminder to keep your anal area clean to prevent any abscesses from forming. Pleasant Day.

The picture was somewhat the same with the above patient but the position was a little bit lower.


Be a Medical Assistant

In the field of medicine, its somehow eases the work load if you have someone to help you and assist you in hospital activities, in that time is save and more work can be done.

Being a medical assistant is both great for earning at the same time learning. The medical assistant employment industry now is growing and could became the next fast growing occupation in the next decade. So how does one became a medical assistant to have earning and learning benefits. One can take a quick course of being a medical assistant at St Augustine School of Medical Assistants. St Augustine School of Medical Assistants offers long distance education services, no traditional classrooms and you can take courses through the net and be a competitive medical assistant in about 6 to 8 weeks. Their education program for medical assitants is reviewed and designed by the best professionals in the field to give you the very best training and education. So why wait be a medical assistant and join the great medical assistant school St. Augustine School of Medical Assistants.


5 cm Lacerated Wound

>> Tuesday, October 28, 2008

During my tour of duty yesterday at the ER, I chance upon a 55 year old male who suffered a lacerated wound around 5 cms in length above his left eyebrow. He was allegedly drunk and he decided to urinate on a concrete wall then after he suddenly fell to the ground hitting his head, left side causing the said laceration.

So materials were prepared for suturing. I gave it 5 stitches to closed the gaping wound. Anti tetanus were also administered owing to the dirty wound that the patient had. I then advised the patient to follow up at our OPD for removal of his sutures. After the patient, no patients under surgery showed up until morning. I grab myself a good sleep devoid of calls. Pleasant Day

The picture above shows an example of wound suturing


TB of the Bone

>> Sunday, October 26, 2008

The other day, we had a patient, a 23 year old female who was scheduled for ankle debridement the next day. She was diagnosed with TB of the bone 3 months ago and is now up for her 2nd ankle debridement.

3 months ago, she came from Macau, she probably had a soft tissue infection which was taken for granted. When she came back from the Philippines, she was already limping and her left ankle was somewhat inflammed. She sought consult with an orthopedic surgeon and was diagnosed to have Osteomyelits (bacterial infection of the bone) and was given antibiotics. After a few days, her condition didn't improve and was advise for debridement of her left ankle. During the operation, pus was noted from her ankle and this was sent for culture and in turn out to be positive for acid fast bacili which is diagnostic for tuberculosis. After that, she was started on anti tuberculosis medications and yesterday she had her 2nd ankle debridement.

The bone is one of the extrapulmonary sites wherein Tuberculosis can set in, it is usually uncommon compared to pulmonary tuberculosis but it is more harder to treat and usually takes longer and is more expensive. As far as I can remember TB of the bone usually take around 10 to 12 months of medications compared to only 6 to 8 months of treatment when dealing with pulmonary tuberculosis. So, if you have any skin infection don't take it for granted but consult a doctor. Pleasant Day

The above picture shows Mycobacterium Tuberculosis which is the causative agent of tuberculosis.


Pupu Irrigation

>> Thursday, October 23, 2008

This afternoon I was again assign at the out patient department of surgery. Seen a couple of patients, gave advises and then I was down to the last one. The last patient was a 62 year old female who came for follow up at the OPD. She underwent hemorrhoidectomy 2 weeks ago and came to OPD complaining of no bowel movement since 6 days ago.

So after getting the history of his complaint, may resident examined her and advise to insert two Bisacodyl (Dulcolax) suppository per rectum. Then we waited for her patiently hoping that she will defaecate. An hour was given to her, my resident left me at the OPD and gave me instructions that if after one hour no bowel movement was seen, I need to do colonic irrigartion. So I crossed my fingers hoping that the patient would defaecate, she went to the bathrum several times but unfortunately nothing happened.

So times up, after an hour I prepared the materials needed for the colonic irrigation. I inserted a foley catheter via her rectum, and gave her a lavage hoping her feces would come out. After doing the lavage, I was hoping the smell of the feces won't stick on my shirt, lucky for me it didn't. What an experience, actually it was my first time to do a colonic irrigation, and it didn't give me a good first impression. Now, it just gives me a slight disgusting feeling when I remember the smell and the color. Pleasant Day


A Night of Vehicular Accidents

>> Wednesday, October 22, 2008

Last night I was on duty at the ER under the surgery service and the ER was full of peoople. All doctors in each department had their hands full, from the ER department, OB-GYN, Pediatrics, Medicine and who can forget Surgery. The night was filled with vehicular accidents, and they were usually hit by a motorcycle. Other patients suffered only mild concusions but I have one particular patient who came all down from the province, suffered a subarachnoid hemorrhage.

Patient came from Batangas, a southern provcine here in Luzon. According to her she was walking on the sidewalk when a speeding motorcycle hit her causing her to be thrown away and her head to hit the ground. Upon arriving, although she was oriented to the place she suffered a big hematoma on her right eye, big enough that she cant open her right eye. Aside from the bulging hematoma, she also suffered a lacerated wound on her head (left parietal area), it was oozing with blood and I had two make two stiches just to stopped the bleeding. Patient was then sent for a CT scan of the brain to see for any problems. Although the patient was conscious and coherent she was noted to have a subarachnoid hemorrhage. Patient was admitted to the ICU for close monitoring.

After that was done a couple of patients came in the early hours of the morning, still due to a vehicular accident. Eventually after that the ER crowd subsided, and I got my well deserve rest. Due to this increasing cases of vehicular accidents happening on the streets, motorists should pay attention to the road signs and should also acknowledge pedestrians and pedestrians should also take safety precautions for them not to end up in the hospital. Pleasant Day


Talipes Equinovarus

>> Monday, October 20, 2008

Talipes Equinovarus or more commonly known as "clubfoot" is a congenital defect wherein the affected foot is smaller than the normal size and the heel pointing downward and the fore foot turning inward.

This afternoon I met a 27 day old female infant with the said deformity. The affected foot was the left foot but the other one is normal. She was happily giggling with us but she doesn't know the she has a deformity. She was seen by my surgery resident and she was eventually referred to an orthopedic surgeon. The orthopedic surgeon made a cast with a plaster of Paris on the affected leg and advised the mother the she needs to undergo serial casting and hopefully the deformity will resolve so no surgery will be needed.

The picture above resembles the foot of the patient I ve mentioned from this afternoon, hopefully for her, the deformity will resolved with casting and hopefully no surgical intervention is needed. Pleasant Day


Surgery Day One

>> Saturday, October 18, 2008

Yesterday marked my first day in my surgery rotation and I was assigned to the OPD (out patient department) for surgical excisions that are usually scheduled every Friday. Two patients showed up for excision yesterday, one was a 29 year old female for a breast mass excision and the other was a 31 year old male for excision of a cyst on his right middle finger. First one up was the female, my surgery resident did the excision. Although the mass was quite small around 1 x 1 cm, it took him a long time, because the mass was somewhat deep, but still after around 20 minutes the mass was excised, bleeders ligated and dressing was eventually applied.

The excision of the cyst in the finger was assigned to me. It was a movable cyst, soft non tender measuring less than 2 cm by 2 cm. After the materials were prepared, I started by doing a digital block of local anesthesia (lidocaine)to numb the surgical site. The I made a linear excision exposing the cyst, after exposing it, I cut its based and it was eventually free. Sutures were applied to the 3 cm excision wound. After the excision, the patient joked with his wife regarding his finger. That summed up my first day in my surgery rotation. Hopefully more cases will come. Pleasant Day

The picture above shows close resemblance to the cyst that I excised yesterday.


End of ENT Rotation

>> Wednesday, October 15, 2008

Today marks the end of my ENT rotation. I spent 1 week in ENT and tomorrow ill begin my rotation in Surgery. For the past week I was quite sad not being able to assist in any ENT surgical procedures because none were scheduled. For today most of the cases I saw in the out patient were acute sinusitis and the common otitis media. For the past week some of the children if not all, had an impacted cerumen either in one ear or having it in both ears. Although devoid of ENT surgical cases, I still enjoyed my week in the field of Otorhinolaryngology or commonly known as ENT. Tomorrow as I enter another rotation, hopefully I ll be geared to face the new cases which I will encounter in the coming rotation. Pleasant Day.


A Case of Peritonsillar Abscess

>> Tuesday, October 14, 2008

We had a 25 year old male patient in ENT diagnose to have peritonsillar abscess. The problem started 6 days prior to admission when the patient complained of sore throat accompanied by dysphagia (difficulty in swallowing) and odynophagia (painful swallowing) and fever, patient just medicated with paracetamol. 2 days after still with the mentioned symptoms patient sought consult and was given home meds. Persistence of the said condition, patient was then referred to ENT service for further evaluation and managament. Patient was diagnosed to have peritonsillar abscess and underwent tonsillectomy.

Tonsillectomy is the surgical removal of the tonsils if it produces symptoms such as obstrucstions, infection and many more.Absolute indications for tonsillectomy include: Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications, Peritonsillar abscess that is unresponsive to medical management and drainage documented by surgeon, unless surgery is performed during acute stage, Tonsillitis resulting in febrile convulsions, Tonsils requiring biopsy to define tissue pathology. Relative indications include: Three or more tonsil infections per year despite adequate medical therapy, Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy, Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase-resistant antibiotics, Unilateral tonsil hypertrophy that is presumed to be neoplastic.

For the patient, tonsillectomy was done because his abscess was unresponsive to medical management. After the surgery patient was eventually ok and was eventually discharge. Pleasant Day.

The picture above shows a sample of a peritonsillar abscess.


Post Graduate Course

>> Saturday, October 11, 2008

Yesterday I attended a Post Graduate Course at the southern part of Metro Manila, it was entitled "Approaches to Common Diseases by Today's Internist". It was sponsored by the department of Internal Medicine. It featured many lecturers which talked about common symptoms which one would usually see as an out patient. Lectures included topics about dizziness, anemia, adult vaccination, heart attack and many more. It was a great learning experience especially for me. The lecturers discussed current trends regarding the management of the above mentioned topics.

Aside from the lecture, the post graduate course also offered great food. In the morning it offered great sandwiches with pasta for the morning snacks. Roast beef w/ vegetables was served for lunch. The roast beef was great but what really caught my tongue was the dessert. It was named "Crepe Samurai w/ Vanilla Ice Cream", its a dessert which could be featured in cooking shows on tv. Congee was served for the afternoon snacks.

Aside from the things I ve mentioned above, another highlight of the course was the exhibit by the different drug companies.. They gave a lot of freebies like pens, bags, toilet paper holder, lots of brochures to promote their products. I was like carrying 4 bags on my way home.

As a whole it was good experience which I would glad to attend again. Pleasant Day


Perforated Tympanic Membrane

>> Thursday, October 9, 2008

Imagine yourself not being able to hear, its like seeing things around you moving but you not being able to understand them that's why the ears are really needed to be given good care. Today marks the first day of my ENT rotation. This morning I met a 68 year old female diagnose to have a perforated tympanic membrane. She was advised to have a CT scan to check the extend of the perforation and to know what type of operation is appropriate for the patient.

The tympanic membrane or usually known as the ear drum, this is the shiny thing when you look inside an ear. The tympanic membrane separates the outer ear from the middle ear and is the organ responsible for hearing. When sound vibrations reach the ear, the tympanic membrane sends the vibrating signals to the middle ear then in turn it goes to the inner ear which produces sound thus making us hear. Ear drum perforations usually could heal on its own but as for the patient mentioned I think the perforation is quite big which makes her deaf on her right ear.

Hopefully after being CT scanned, the extent of the damage wont be that great so she could still regain normal hearing with her right ear. The sense of hearing is important, without it life can be boring and dull, so proper care should be given to our ears. Pleasant Day.

The picture above shows a normal tympanic membrane.


End of Ophthalmology Rotation

>> Wednesday, October 8, 2008

Today marks my last day in my Ophthalmology rotation which lasted for a week, tomorrow ill be headed to the Otorhinolaryngology department or known as ENT (ear, nose, throat). Ill have to say goodbye to eye conditions and be headed to conditions affecting the other parts of the face.

To recap my day, we saw two patients in the morning basically complaining of blurring of vision. Bought of them were diagnose to have blepheritis. Blepheritis in an describes as inflammation of the eyelids. Both of them had the same diagnosis and both were given the same type of oral and topical antibiotics. After seeing both patients, I was given my post-rotational exam, it was a 30 item exam, I think I could pass that exam with flying colors. We only have 1 patient seen in the afternoon. It was a 65 year old male just on his follow up regarding the status of his cataract. Patient was eventually advised and discharge. My evening was filled with patients compared to both the morning and afternoon sessions. We had a total of 5 patients, we were to be off by around 7 in the evening but we ended the evening session at around 8:30 in the evening. Before going home, I had dinner with some of my peers at a nearby fast food store. After filling my empty stomach, I was headed home.

Tomorrow, I ll start in another department, hope to see different cases to add to my learning in my 1 week stay in ENT. Hopefully it will be a happy experience. Pleasant Day


An Article From a Filipino MD

>> Monday, October 6, 2008

In one of my readings, I came across this article made by a Filipino doctor pointing to the struggles of a doctor here in my country and I want to share it out.

A Fighting Chance
by Michael Hussin B. Muin, M.D.

The ‘Sell Out’ stigma has since died down. It is now a footnote in the obscure pages of Philippine medical history. But the exodus continues and the situation is a fierce topic in conferences. Even business schools have taken up the issue and debated on the reasons of the plight and flight of doctors and the effects on the public administration of health care. And the conclusion has taken a gentler form. No, they now agree, doctors didn’t sell out, they just gave up fighting.

And what are they fighting for? Among other things, doctors—and other health workers—fight for better pay and better working conditions. They fight for protection from bogus health companies and quacks in government. They fight for stronger organizational leadership. They fight for a better government. They fight for their patients. They fight for their families.

It is a sad fact that bank tellers and call center agents get better pay than general physicians in HMOs and residents in training. Bank tellers may get as much as P15,000 per month while GPs get P9,000-P12,000. Call center agents get as much as P21,000 per month while residents in private hospitals are lucky to get anything over P10,000. People who handle money and customer service get better wages than those who handle lives. This says much about industry standards, whatever that means.

But isn’t it true that all Filipinos are fighting for higher wages? Yes, but the fight is done in different ways and have different effects. When factory workers stop working, production goes down. When jeepney drivers wage a strike, transportation grinds to a halt. But when doctors go on strike, patients die.

I have seen doctors fight for a collective cause. They threatened work stoppage at a small private hospital unless conditions for better pay were met. They gathered just outside the emergency room and carried placards and signs. But the whispers and conversations within carried in them the futility of their efforts.

‘Tawagin mo ako pag may dumating na pasyente.’

‘Akyat muna ako at mag-a-assist ako sa OR.’

‘Sandali lang, andyan na yung follow-up ko.’

These are phrases uttered by the doctors on strike. Even the venue of the strike is crucial. They to sit it out in front of the emergency room and scramble in when an emergency case arrives. Once the patient is stabilized and brought up to the floors, they then trickle back into the strike area, anxious and ready for another case.

Doctors are not immune to the effects of graft, corruption and poverty. Some doctors are unemployed, while others take double or triple jobs. Many doctors look outside the field of clinical medicine for extra income. Some are into related fields like academics and research, while others go beyond medicine and venture into medical transcription, nursing, information technology and selling jewelry and health insurance.

Not everyone has government officials and actors for patients. In Batangas, moonlighting specialists settle for P1,000 for normal deliveries and P3,000 for caesarian sections. In the provinces, doctors are often faced with poor patients—and rather than exacting consultation fees, most instruct the patients to just buy the prescribed meds with what is left of their money.

Doctors are pinned to the wall. If they fight back, people die. But if they don’t fight back—well, they go home tired and weary. In any case, the health of Philippine society hinges on the Filipino doctors’ sense of decency—the decency to put the patient first—above anything and everything, even their own needs.

Hospitals and managed health companies exploit this sense of decency to a fault. They know doctors will not abandon patients. Yes, some paper work will be delayed if work stops, but they have administrative clerks for that. Patients will still be treated, surgeries will still be performed, follow-ups will still be done.

So, how will doctors fight back without hurting their patients? How will they go to the streets and protest unjust compensation? How will doctors fight unseen ghosts and forces that threaten to push them to acts of indecency and selfishness?

By bringing the fight closer to home. Everywhere doctors are questioning the choices that lay before them. While society continues to flourish in the notion that doctors get full satisfaction from public service, doctors struggle to face the harsh reality that life is full of shit. There are no right choices, just promises and responsibilities to keep. There are no wrong decisions, just consequences and the courage to live with them.

The fight to leave or stay—and yes, it is a fight—is not found in the loud voices on the streets and the echoing chants in demonstrations, but in the grave discussions at dinner tables and the whispered conversations when the children are asleep. Because doctors are slowly finding out that living—and leaving—for one’s family is a battle worth fighting for.

For some, it has come down to choosing between loneliness and poverty. Some choose to be lonely, while others choose to be poor. Doctors are not leaving, they are driven away. And these doctors carry their own personal battles in foreign lands, where they fight extreme depths of loneliness and immense levels of uncertainty. Those who stay fight their own battles of survival, where each day is a search for some sense of meaning in the care of other people’s lives.

In the gloom spreading all over the country, people are asking for a chance to get past poverty, a chance to make a difference, a chance to rise above the muck of helplessness. In the current state of desperation, people are looking for a fighting chance. And everybody deserves a fighting chance—even doctors.

------------ ---------

Michael Hussin B. Muin, M.D. is the Founder and Editor-in-Chief of Pinoy.MD - The Website for Filipino Doctors. He is a professor of Clinical Anatomy and Medical Informatics in Pangasinan.


First Day of OB-GYN review

>> Saturday, October 4, 2008

For the month of October, our review sessions will be handled by the OB-GYN department. Our review started around 10 in the morning. The chief resident of the department gave us the review with a quite long lecture on the physiological changes happening during pregnancy. The lecture was presented via a power point presentation with 205 slides. She discussed changes occurring in every system of the body, from the respiratory, cardiovascular, genital changes, and many more. She also gave us some tips about must knows that might appear in our coming board exam next year. The review ended near lunch time and we had lunch with my peers at a nearby pizza parlor. After then I spend some chit chat time with my peers then I was home ward bound again.

The chief resident gave quoted a quote which up to now is stuck in my head, she said "Pregnancy is the most common pathologic condition occurring in woman". Pleasant Day


First Day High in Ophthalmology

>> Thursday, October 2, 2008

After my pediatrics rotation, today is my first day in the department of ophthalmology. Ophthalmology is the branch of medicine which deals with the disease of the eye and also is the one responsible for doing eye surgeries. The last time I held an ophthalmology book was last year, so I need to do some homework before doing my history and physical examination in ophthalmology.

I was scheduled to meet 3 ophthalmologists today, one in the morning, another in the afternoon and the last is in the evening. The morning session was unremarkable, we were excused because of a lecture to be held around 10 in the morning and we were required to attend. The afternoon session was filled with two patients. One was a little girl while the other one was follow up patient after undergoing cataract extraction 2 months ago. After showing the patient to the consultant, he taught some basic but valuable must knows in the field of ophthalmology. My evening session started around 5:30 in the afternoon, there were around 5 patients. Most of the complaints by the patients were not that serious. After presenting the 5 patients, the consultant signed are attendance sheets and I was done for my first day.

I was a bit nervous today, but after undergoing those 2 ophthalmologists, I thinked I ll be ok by tomorrow. Another set of 3 ophthalmologists tomorrow, hopefully I won't loose my nerve in front of them. Pleasant Day.


Last Day Agenda

>> Wednesday, October 1, 2008

As I have mentioned in my previous post, yesterday was my last day at the NICU, and the last day of my pediatrics rotation. Before leaving a nice case presented yesterday, he was a 15 day old premature baby, previously to be healthy, with good cry and good suck. He was already weaned out of the incubator but around 2 days ago, he was returned back because his lips was starting to be cyanotic (bluish-purple discoloration). He was up for 2D echo last saturday unfortunately the pediatric cardiologist wasn't available. Yesterday the heart 2D echo proceeded, and to my surprise he was diagnosed to the transposition of the great arteries. The arteries being referred here are the aorta and the pulmonary artery.

Transposition of the great arteries is wherein the aorta and the pulmonary artery have exchange places. The pulmonary artery took the location where the aorta should be and vice versa. So instead of the aorta pumping oxygenated blood, it pumps unoxygenated, and the pulmonary artery instead of pumping unoxygenated blood it pumps oxygenated blood. This can cause cyanosis because the body lacks the oxygen requirement it needs which it gets from the blood, in our baby it presented with cyanotis lips. If left untreated it could proceed to heart failure and eventually lead to the babies demise.

The baby was then arranged to be transferred to the Philippine Heart Center for a possible heart surgery (if financially possible). I also had a talked with the mother, she was really concerned with her child's condition and was somewhat teary eyed. Hopefully the baby could get the funds for the surgery and eventually survived and eventually be a normal child.


End Of Rotation

>> Tuesday, September 30, 2008

Today was my last day of my pediatrics rotation. I spent it at the NICU, there were two babies delivered today during my stay at the NICU. Before saying goodbye to my residents, we bought "pansit" and "crispy pata" for their lunch as a way of saying thank you for a wonderful stay at the department of pediatrics. Next I will be assign to the Ophthalmology section, taking a look at those patients with eye problems. After signing out around 5 in the afternoon, I bade them goodbye and with a smile left the office. So another chapter has ended and another is about to start. Pleasant Day.


Sunday Blues

>> Monday, September 29, 2008

Yesterday I had my last duty on my Pediatrics rotation. Ill be transfering to another department coming this Wednesday. The sad thing about yesterday is, I m the only intern on duty, what a way to spend my last day at Pediatrics, alone. :(. Anyways the day went like a breeze, spend my morning at the nursery then visited one of my friends at the ER. Although I m hospital alone yesterday, something made me smile. I catched a baby which broked the record being the heaviest. In one of my previous post, I mentioned a 9.8 pound baby which I catched and eventually he held the record being the heaviest. But dawn today I was astonished, we had a stat c-section around 1 in the morning, and the baby then came out was a big one. After being weighed, she was a 10 pounder. She was really big indeed, in terms of Filipino weights of newborns. I called her "Dumbo the 2nd", the first being the 9.8 pounder I catched days ago. Afterwhich I headed to the quarters, and took my sleep around 3 in the morning. Now I m awaiting lunch, then ill be homeward bound again. Pleasant Day.


How To Survive A Heart Attack Alone

>> Saturday, September 27, 2008

I got this informative power point presentation given to me by a senior doctor and I want to share it with you, maybe it wont be helpful now but it may give some help in the future. Here is the scenario:

Let's say it's 6.15pm and you're driving home (alone of course) after an unusually hard day on the job. You're really tired, and frustrated, stressed up and upset.

Suddenly you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw.You are only five miles from the hospital nearest your home. Unfortunately you don't know if you'll be able to make it that far

You ask yourself what to do? You have been trained in CPR, but the guy that conducted the course did not tell you how to perform it on yourself.

Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.

So here is what to do: Do not panic, but start coughing repeatedly and very vigorously. A deep breath should be taken before each cough, the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every 2 seconds without let-up until help arrives or until the heart is felt to be beating normally again.

Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital. (this article was published on number 240 of journal of general hospital rochester)

Another added information to myself, hopefully it could also be beneficial on your part. Pleasant Day


Medical Terminology

>> Thursday, September 25, 2008

Anally......................Occuring Annualy
Antibody....................Against Everyone.
Artery......................The study of paintings.
Bacteria....................Back door to cafeteria.
Bandages................... The Rolling Stones
Barium......................What doctors do when patients die.
Benign......................What you be after you be eight.
Botulism....................Tendency to make mistakes.
Bowel.......................Letters like A, E, I, O, or U.
Cesarean Section............A district in Rome.
Catscan.....................Searching for Kitty.
Cauterize...................Made eye contact with her.
Colic.......................A sheep dog.
Coma........................A punctuation mark.
Cortizone...................The local courthouse.
D&C.........................Where Washington is.
Dilate......................To live long.
Diaphram....................A drawing in Geometry.
Enema.......................Not a friend.
Enteritis...................A penchant for burglary.
ER..........................The things on your head that you hear with.
Fester......................Quicker than someone else.
Fetus.......................A character in Gunsmoke.
Fibula......................A small lie.
Fibrillate..................To tell lies
Genital.....................Non-Jewish person.
Genes.......................Blue denim slacks.
G.I. Series.................World Series of military baseball.
Grippe......................What you do to a suitcase.
Hangnail....................What you hang your coat on.
Hemorrhoid..................A male from outer space.
Herpes......................What women do in the ladies room.
Hormones....................What a prostitute does when she doesn't get paid.
Impotent....................Distinguished, well known.
Inpatient...................Tired of waiting.
Labor Pain..................Getting hurt at work.
Medical Staff...............A Doctor's cane.
Menopause...................Button on a VHS remote control.
Morbid......................A higher offer.
Minor Operation.............Somebody else's.
Nitrates....................Cheaper than day rates.
Node........................Was aware of.
Outpatient..................A person who has fainted.
Organ Transplant............What you do with your piano when you move.
Organic.....................Church music.
Pap Smear...................A fatherhood test.
Paralyze....................Two far-fetched stories.
Pathological................A reasonable way to go.
Pelvis......................Second cousin to Elvis.
Pharmacist..................Person who makes a living dealing in agriculture.
Plaster Cast................The drunk roadies backstage at a rock concert.
Platelet....................A small plate or platter.
Post Operative..............A letter carrier.
Protein.....................In favor of young people.
Recovery Room...............Place to do upholstery.
Rectum......................Damn near killed him.
Saline......................Where you go on your boyfriend's boat.
Scar........................Rolled tobacco leaf.
Scrotum.....................Small planet near Uranus.
Secretion...................Hiding something.
Serology....................Study of English Knighthood
Seizure.....................Roman emperor.
Surgery.....................A reason to get an uninterruptible power supply.
Tablet......................A small table.
Terminal Illness............Getting sick at the airport.
Testicles...................Found on an octopus.
Tibia.......................A small country in North Africa.
Triple Bypass...............Better than a quarterback sneak.
Tumor.......................An extra pair.
Urine.......................Opposite of you're out.
Vagina......................Heart trouble.
Varicose....................Real Close / Near by.
Vulva.......................Automobile from Sweden.

Pleasant Day


Systemic Lupus Erythematosus - a Self Killer

>> Wednesday, September 24, 2008

Yesterday I attended a case presentation at our hospital regarding the dreaded systemic lupus erythematosus or just known as SLE. The presentation area was filled with lots of people to listen to the case being presented by one of my residents. We also had a rheumatologists as a resource speaker.

The case being presented was a 15 year old female presenting with rashes. 2 weeks prior to her admission she already sought consult and was diagnosed then to have measles, the rashes however did not wear off. Eventually additional symptoms were added until she was admitted. She was referred to rheumatology department for SLE workup and through enough she was diagnosed to have SLE.

Systemic Lupus Erythematosus is an autoimmune disease that affects multiple organ systems.Normally, the immune system helps protect the body from harmful substances. But in patients with an autoimmune disease, the immune system can't tell the difference between harmful substances and healthy ones. SLE if not controlled can be fatal.

Symptoms of SLE usually vary from one person to another because it can affect different organ systems. The clinical criteria in diagnosing SLE usually involves 11 manifestations. This 11 are: malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder and a positive antinuclear antibody. A person should present at least 4 of the 11 given to be diagnosed to have SLE.

Steriods are the main stay in SLE treatment. Advances in research and medicine have decrease the number of fatalities from the dreaded disease. Treatment doesn't just involve medications but family support and patient education also proves important. Prognosis of patients with SLE have improved over the past few years. Hopefully in the future newer medications are discovered with lesser side effects and hopefully one day a cure can be found.

The picture above shows the typical malar rash found among SLE patients. Pleasant Day


Osteoporosis - the Silent Epidemic

>> Tuesday, September 23, 2008

Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine, wrist, hip, pelvis and upper arm. In many affected people, bone loss is gradual and without symptoms or warning signs until the disease is advanced. Osteoporosis is a global problem which is increasing in significance as the population of the world both grows and ages. For these reasons, osteoporosis is often referred to as the "silent epidemic".


Primary Osteoporosis - caused by estrogen deficiency. It is much more common in women than men. Type I - is called "postmenopausal osteoporosis," typically occurring within 15 to 20 years of menopause. Type II - is caused by low calcium. Chronic calcium deficiency leads to decreased bone formation and fragile bones. Type ll osteoporosis usually occurs in people over 70 and is, therefore, called "senile osteoporosis."

Secondary Osteoporosis - is age-related osteopororosis generally seen in the elderly of both sexes, especially after age 70, due to long term remodeling inefficiency, dietary inadequacy and activation of the parathyroid axis with age

Unfortunately there are very few physical warning signs for osteoporosis until the disease has established itself. Broken bones or fractures after a minor bump or fall may mean you already have osteoporosis, and this is often the first sign of the disease.

Osteoporosis occurs when the body fails to form enough new bone, when too much of the old bone is reabsorbed by the body, or when there is an imbalance between Osteoclast and Osteoblast activity. The 2 essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer. Calcium and phosphate may be reabsorbed back into the body from the bones, making the bones weaker. Both situations can result in brittle and fragile bones that can break easily.


Antiresorptive drugs, already available, slow the progressive thinning of bone.

Bone-building agents help to rebuild the skeleton and are now becoming available or are in the developmental pipeline

Non-pharmacological interventions are also very important in reducing the risk of fracture.

All of the above mentioned treatment strategies need to work hand in hand to prevent Osteoporosis from being such a pain. Pleasant Day


Peed by a Newborn

>> Saturday, September 20, 2008

Still in my NICU rotation with a new set of clinical clerks under me, I had 6 catches yesterday. All of them were still admissions of the previous duty but all of them gave birth during my tour of duty.

One of the highlights of yesterday's delivery, was a 9.8 pounder baby boy which was delivered via outlet forceps extraction. Among Filipino babies, the normal weight of a newborn is around 3 to 4 kilograms, but this babied weigh 4.3 kgs., big in terms of Filipino newborn weights. He was really heavy, and carrying him around could make your arms fatigue easily. At least all of us at the nursery, from my residents, nurses and my peers were happy to see such a bouncing big baby boy. All of us took turns in teasing the baby.

The last highlight of the day yesterday was my last baby catch. He was a term baby boy born around 6 pm. So after the delivery, we cleaned him up, offered oxygen, did some suctioning. Then just when he was to be clothed with new linen for him to be transported to the isolette, he gave out his first urine output, unfortunately he was facing me, so his pee went directly to my scrub suit. Talk about a happy moment, so I was there looking intensely at him and looking at the wet part of my scrub suit but he looked at me back and gave a soft cry. Just told my self, he is only a newborn and he doesn't now what he is doing to console myself. We had no admissions during the evening and had a good night rest last night. Pleasant Day



>> Wednesday, September 17, 2008

Still in my NICU rotation, a new bunch of clinical clerks had just started to rotate in pediatrics. So I oriented the clerk assigned to the NICU, things to do and what things to monitor. So again another duty has ended. Yesterday was guite tiring, had dinner at 2 in the morning. Talk about super late dinner, looks like I m already having early breakfast.

We only had a total of 5 admissions for my tour of duty. All were term babies, but one of their mothers arrived in the hospital fully dilalted. After having late dinner at 2 in the morning, I headed to the bed thinking that there won't be any more admissions for the rest of my duty. Then after being half asleep for an hour, my cellphone rang, the OB intern told me that they had a patient for admission but is still in the ER. So I stood up and headed to the ER to check the patient and get some history regarding her pregnancy. While talking to her, she told me that it was already her 5 pregnancy, so I told myself this labor won't last long. So after doing my routine interview, I sat down at the desk scribbled the data I got in a piece of paper, internal exam was again done on the patient, then I heard "Fully...Fully.." (patient is already fully dilated). Feeling the rushed I then jumped from the sit, grabbed my gear, informed my resident and then headed to the delivery room. Just in time, I had catched the baby. It was a healthy bouncing baby boy. After cleaning the baby, I carried it to the mother and she had her first glimpse of her baby boy.

Such joy filled me seeing mothers smile looking the their newborn. Pleasant Day


Monday Morning Endorsements

>> Monday, September 15, 2008

Another Monday has dawned upon me, another start of the week. Woke up a little bit late, skipped breakfast and then on the way to the hospital. Took the same route to the hospital, but not so sure if the bus i rode was the same as that of yesterday. Same scenery, same rush, came in just in time for the morning endorsements with a pediatric consultant.

The people of yesterday's duty gave it the morning endorsements, they had a total of 10 admissions. Cases range from acute gastroenteritis, acute dyspepsia, to hemolytic uremic syndrome. Each case was discussed in detail from the history to the management. Certain in between questions were asked to the clerks, us interns and also to our residents by the consultant. The endorsement lasted nearly 2 hours then we returned to our respective posts.

Morning endorsements always give us the rush, not just your usual morning. Afraid to be scolded by the consultant, afraid that your history will have a lot of holes for the consultant to shoot at, afraid that you can't answer the questions being hurled at you. But in the end, after each endorsement, new lessons are learned, more than enough compared to the morning rush given by the daily morning endorsements.

Morning endorsements are best with a cup of coffee on the table. Pleasant day


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