Assalamualaikum
I started my day of feeling moody which i swear that my face would multiply the age if i woke every morning feeling like that! We had no bedside teaching today, thank God for that when they sent us an orthopedic surgeon instead of general surgeon. Well at least they share the same last name. So we went to SOPD of teluk intan instead. Met a lot of doctors, numerous ukm medical students, and some patients. So crowded laaa i mean even doctors need to share a room here. With only 4 available rooms packed with max 3 doctors per room, there still some doctors that had to use pantry and other rooms to do follow up on patients. Back there in sg buloh, every doctors would get their own comfy room with better space to move around. Here, they got only ONE specialist and about 4 Mo to work on clinic as referral to young HOs per session. So i got this young chinese young house officer as my sort of like sifu for today session. He was very kind though, eccentric doctor (as he kinda happy go lucky person compared to other serious looking one). And for today i saw a case on paraumbilical hernia, umbilical hernia, multilobular goitre (other friend punya case), inguinal hernia, new diagnosed patients with ca, bph patient with history of sigmoid ca. Well basically another day of hernia plus bph. BPH is benigh prostatic hyperplasia which is a very common incidence in old man. Though lots of patient came, we still couldn't see the 'thing' la. Out of modesty, the patient would claim his right not allowing us female to see. Its not okay for us as we just want to learn la pakcik :(
Alas, here is what i learnt la for a bit:
1. An old Chinese man came alone, walking limply into room using a stick. He had previous history of removed sigmoid ca (T3N1M0)back in 2009, already completed chemo cycle. F/U with chief complain of increase frequency in urination, disturbing him from sleep at night. Recent PSA test shows high level of PSA value >10ng/ml, exceed age-specific-reference-range. The first thing came into my mind was is it metastasize already? Then i got to know PSA is a marker for both BPH and prostate ca *i tot it only for ca! *. However, to be safe, the doctor referred him to selayang for further investigation to rule out any malignancy though he was diagnosed to has BPH at first. Point to note was that, i myself was not being so sensible at that time! I should at least walk him to the door and opened the door to him kot as i got to see he got some sort of
abnormality with his hand, plus that he is a limper. boooo to your manners!
2. A middle age Chinese lady came alone with his husband to get result for her wide excision biopsy done before for a lump in her right breast. The doctor broke out the news that she got ca and has to undergo elective surgery of removing her breast for her sake. The doctor indeed did a very good job explaining the options available to her patiently all the things that need to be taken care from now. The wife looked calm and husband was more worried, asking questions here and there showing how caring he actually is. The husband and wife asked for option not to remove the breast, but the doctor warned it is not the best choice ever for her stage. Diagnosed with only stage 2 but to be cautious the doctor want to do total mastectomy with axillary clearance.
3. A middle age Malay man came to the doctor with c/o painful urination (dysuria) and incontinence. Had history of renal stone on his right kidney that was resolved with laser. The pain was on his right flank and radiated down below into his groin. No history of fever and renal punch was negative (TRO any infection of kidney). X ray KUB show some white round area (that can indicate the stones) but in his bladder not the kidney itself or ureters. Thus the doctor kept the patient to come again (TCA) in 2 weeks time by giving medication first. I thought it is best to do ultrasound lah bcos the patient already had history of it but the specialist knows better what to do (maybe bcos of of limited access?).
4. A middle age jobless Indian male with background history of cirrhosis and esophageal varices came for follow up (F/U). On PE, the abdomen in distended, non tender, palpable liver edge, reducible umbilical hernia and positive fluid thrill. He was a chronic drinker before that lead him to liver cirrhosis. Long standing liver cirrhosis lead up to ascites (positive fluid thrill) due to high pressure in blood vessel of liver and hypoalbuminemia . Ascites which is accumulation of fluid in abdominal cavity cause increased intraabdominal pressure that push the bowel onto umbilicus. Resulting in umbilical hernia. Regarding esophageal varices (extreme dilation of sub mucosal veins in lower esophagus), it is another complication of liver cirrhosis that cause portal hypertension. The patient ask for continuation of medication for his enlarged liver but the doctor couldn't do so because the surgical department only treat for his presenting complain which is esophageal varices. Ermmm i wonder, why not treat the patient on a whole?
5. An old Chinese man came for F/U to get the result for his colonoscopy accompanied by his two grown up children. Bad news and further investigatory plan (staging, CT scan) didn't well received by the son. The old man back then came with complain with altered bowel habit and loss of weight, now being diagnosed to has rectal ca. And the son asked either it is colon ca, because the name is rectal ca. Actually, rectum is a part of colon too though the most distal one. The term usually used is colorectal ca instead of just colon ca. And the most common site of colon ca is rectum lah. The son wanted a copy of HPE result to get second opinion as they didn't want to wait in line. So heart pounding la to get this kind of patient >.<
After all, THANK YOU A LOT to dr michael for letting us bugging you while working.yeay you are the best la dr! you totally make my day exhilarating.
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