surgery

this week has been tiring no doubt. i can barely open my eyes.

however, Mr. R and Mr. I have taught us precious bits of knowledge this whole week.

am really thankful to them although i come home with a splitting headache everyday.

osteoarthritis

wokay, so today we formally start the group discussion. todays case was a patient with bilateral knee pain worse on the left. i'l write down what i remember in hopes that all this becomes long term memory.

right.

bilateral knee pain- ask all the relevent questions

any swelling? any deformity?reduced quality of life?wear and tear?NSAIDS?

risk factors-female, fat, workload, past trauma, gout

rule out-morning stiffness+hand joints= RA, diet+toe swelling= GOUT fever+DM= septic arthritis

physical:

gait-deformities ( varus/valgus )-swellings ( rule out bakers cyst )

square pelvis ( shortening )-fixed flexion deformity

knee joint-crepitus-milk patella-examine swelling

range of movement

special tests-varus and vulgus test

sensory, pulses

ix:

blood:

RA-rheumatoid factor, anti-nuclear antibodies,ESR

Gout-uric acid

imaging:

x-ray: knee joint AP and lateral view ( 4signs-osteophytes,subchondral cyst,subchondral sclerosis, narrowing joint space )

negatively bipheringent crystals-rhombus shaped- gout

management:

1. nonpharmacological ( walking stick, rest, lose weight )

2. pain relief ( usually NSAIDS )

3. intra0articular injections ( hyaluronic acid )

4. Joint debribement ( realignment/osteotomy )

5. knee replacement ( bipolar/unipolar )

that's all for tonight. coz we covered one case only. tomorrow ONG!

another patient

as usual, patients teach us a lot. today i have two patients we shall discuss~

one of my patients presented with symptoms suggestive of acute limb ischeamia. he had a sudden episode of throbbing calf pain and he had all the risk factors: IHD, COPD, Hyperlipidemia and when i examined him, his leg was already cold and mottled his posterior tibialis and dorsalis pedis pulses were not palpable anymore.is leg had to be amputated above the knee because the doppler ultrasound revealed a non-viable limb. what touched my heart is the fact that this patient already presented to the ED twice and was misdiagnosed as cellulitis. he was discharged and now, he had to amputate his leg. whilst he was telling me this story, he blinked back tears which made me sad as well. he told me, do not make the same mistake later when i become a doctor.

another patient today was a known case of hepatoma. i didn't get much of the history bt on examination there was a huge mass arising from the liver measuring 19x26 cm ( i wouldn't be suprised if he' called for our exam ). he let each and everyone of us to examine him, there were 8 of us including prof i think.

the lesson i learnt the most is that patients help us A LOT. the first patient gave me a painful reminder thar misdiagnosing a patient can cost him his leg. the second patient reminded me to be nice, such as this pakcik was. he knew there was not much can be done and still found the will to live and help us medical students acquire the experience.

goes to show that these patients were old, helpless and in pain. while we are just too tired,lazy or give excuses when we have work to do and this might cost us a life. alhough we still are medical students, we should do our work diligently at least starting from now coz old habits die hard and we don't want to do anything wrong when we start working. lastly, the problems that we think might be so big, are absolutely minuscule to what our patients might be experiencing. so don't make a big deal out of it. deal with it. do not say "this is who i am, i get moody/irriatated/merajok/bothered/annoyed by a small mistake". only you have the power to change who you are.

this is bull.

almost to the end of MBBS

i just realized something.

i began with surgery

and i'm gonna end with surgery!

hullaballoooooo!!

the surgeon in me is bursting to come out!!!

( poyo gile )

as age goes

my lecturers have told me: learn from your patient, not only when it comes to medical knowledge but as a whole.

this is completely true, i 'm currently doing ostetrics and gynaecology and our gynae ward is the same one as the female surgery ward. because we have a lot of time on our hands, we go 'cruising' through wards as well, meaning we walk through different wards, catch a patient and clerk them exam style for practice and needless to say, we learn a lot from them.

patients present with a variety of symptoms and hints. this week i had a patient with DM type 1 who came with shortness of breath but turns out had atypical pneumonia and pyogenic liver abcess which caused her to get diabetic ketoacidosis. so while we were clerking her, we asked the standard questions - do you have a boyfreind and are u sexually active? turns out that she has one and she is sexually active. i felt it was my duty to advise her, so after my friend left i had a couple of words to say to her. she seemed to take it well enough. then i went to read her notes, turned out that she was raped 2 years ago by someone she knew and this boyfriend is kind of like her savior.

i was appalled to learn about this. how could someone rape a friend/family member? what caused him to be a monster and rape a 14 year old girl? she had to be admitted to repair a tear at her vagina as well. does he not feel any guilt?

then i remembered the other countless patients who came looking religious but had skeletons in their closet.

1. a religious ustaz who turned out had HIV because he played one time with prostitutes

2. a Muslim man who drank alcohol when he was young and had GI bleeding because of cirrhosis once he reached his 60's

3. an abusive father who developed a stroke and could only moan while his children refused to take care of him at the hospital

i guess the conclusion i managed to dig out from all of this is that Allah has many ways to punish us for our sins whether it is immediate, when we are old,or in the afterlife. whatever our sins might be, they will come back to us. so i guess, i shouldn't be angry towards the rapist, because i can be certain that he will get what he deserves.

p/s: my back saket lagi esp tonight. and i seem to be in a foul mood the whole week. got my social-cultural issue which i had discussed and drafted in my head taken, overslept. hasn't been a good week.