August 13th
Dr Larry assisted me in the Theatre in a Lumpectomy operation - the surgical excision of a "lump"- the lump being located at the middle of the back of this man, a company patient. It was a Lipoma, the size of my fist.
I usually enjoy the part where I scoop-out the fatty lump whole, using my fingers. It then leaves a pot-hole-like space subcutaneously, which I must then close with absorbable sutures.
I failed to mention three weeks or so earlier, a near-fatal incident in the operating Theatre. A male patient almost died even before we began the surgical removal of yet another Lipoma, this time located at his neck, posteriorly.
I usually use local anaesthetic just as I did in today's case. This involves injecting the anaesthetic fluid locally, so as to completely deaden that area to pain.
I proceeded in similar manner that fateful day, whence upon the patient began slowly to act stuporous. Then he began to have violent spasms while screaming at the top of his voice.
Quickly, I gave a steroid shot to his arm. His aggression began to quell down after the shot.
Truth is, I may have given too much of the local anaesthetic particularly as the location was close to the Central Nervous System.
I was chatting with the patient an hour later, the surgery haven been cancelled. He described to me how he was in a death struggle while we observed all that we did those moments in the Theatre. He felt shakey on his feet and weakened.
He recovered fairly fully overnight and was discharged the next day.
Wednesday, August 13, 2008
Friday, August 8, 2008
Chronic Prostatitis . . Benign Prostatic Hypertrophy (BPH) . . Cancer Of The Prostate.
August 8th
It's interesting the way things happen almost in unison. They say "trouble comes in threes".
I've recently been giving a young man on-line medical advice concerning a possible "prostate situation" - as he called it - that he may be suffering from. Then, along came two more prostatic disease situations encountered today.
The first was this forty-something year old man. He suffered a low-grade, nagging pain in his perinium - the area that is between the anus and the scrotum. There was associated pains occassioned in both testes, with straining, before he is able to pass urine and even at that, the urinary stream is poor and it breaks and dribbles.
All these had been on now for several months.
I concluded that he may have Chronic Prostatitis.
Another likely diagnosis of course is a Benign Prostatic Hypertrophy (BPH) which simply put, is a progressive enlargening of the prostate gland which happens not to be cancerous, hence, we say it is benign.
I placed him on prolonged antibiotics therapy. No investigations needed, at least for now.
The second case was a colleague of mine's dad. I didn't see the poor dad myself but only learnt that he had to be taken to the Teaching hospital for an MRI to investigate the possibility of secondary, metastatic spread of the Prostate Cancer he suffers from.
I have been aware that he suffers this disease for a while now, one time he haven to undergo surgery and then commencement of hormonal therapy.
It's interesting the way things happen almost in unison. They say "trouble comes in threes".
I've recently been giving a young man on-line medical advice concerning a possible "prostate situation" - as he called it - that he may be suffering from. Then, along came two more prostatic disease situations encountered today.
The first was this forty-something year old man. He suffered a low-grade, nagging pain in his perinium - the area that is between the anus and the scrotum. There was associated pains occassioned in both testes, with straining, before he is able to pass urine and even at that, the urinary stream is poor and it breaks and dribbles.
All these had been on now for several months.
I concluded that he may have Chronic Prostatitis.
Another likely diagnosis of course is a Benign Prostatic Hypertrophy (BPH) which simply put, is a progressive enlargening of the prostate gland which happens not to be cancerous, hence, we say it is benign.
I placed him on prolonged antibiotics therapy. No investigations needed, at least for now.
The second case was a colleague of mine's dad. I didn't see the poor dad myself but only learnt that he had to be taken to the Teaching hospital for an MRI to investigate the possibility of secondary, metastatic spread of the Prostate Cancer he suffers from.
I have been aware that he suffers this disease for a while now, one time he haven to undergo surgery and then commencement of hormonal therapy.
Sunday, August 3, 2008
Elective Caesarean Section . . H.I.V./AIDS
August 3rd
I'm on my week-end off, however I had to be called to assist Dr Nsisi in performing an Elective Caesarean Section.
I greeted the patient in the Theatre to help cancel some of her anxieties.
The indication for the Section was, a previous Section in the past as well as a Breech presentation currently (buttocks-down position). What this indicates is that a past Caesarean Section would have weakened the potential strength with which the womb can muscularly contract during labour. This fact, now coupled with a Breech presentation which on its own constitutes its own difficulties for the baby's smooth passage, is what informed the decision as regards the mode of delivery.
Hence, the option for an Elective (Planned) Caesarean Section.
The surgery went very well.
I cannot believe I failed to update you - The Hysteric patient with the convulsion. She turned out to be H.I.V. positive. Meaning that her convulsive seizures (or fits) must have been H.I.V. Encephalopathy, though I'm no expert. Simply put, we think the virus has gotten a hold on her brain-cells that are now a bit dysfunctional. The poor woman.
The day I ran up to arrest her convulsions was when I noticed the characteristic dark patches of what was then my suspicion and now obviously Kaposi Sarcoma - a malignant Tumour that is common to many AIDS patients. Then, it could well have been scars from allergic insect-bites. This is very doubtful now as Kaposi's is very much certain to be the case.
She's since been discharged and sent for H.I.V. confirmatory tests.
I'm on my week-end off, however I had to be called to assist Dr Nsisi in performing an Elective Caesarean Section.
I greeted the patient in the Theatre to help cancel some of her anxieties.
The indication for the Section was, a previous Section in the past as well as a Breech presentation currently (buttocks-down position). What this indicates is that a past Caesarean Section would have weakened the potential strength with which the womb can muscularly contract during labour. This fact, now coupled with a Breech presentation which on its own constitutes its own difficulties for the baby's smooth passage, is what informed the decision as regards the mode of delivery.
Hence, the option for an Elective (Planned) Caesarean Section.
The surgery went very well.
I cannot believe I failed to update you - The Hysteric patient with the convulsion. She turned out to be H.I.V. positive. Meaning that her convulsive seizures (or fits) must have been H.I.V. Encephalopathy, though I'm no expert. Simply put, we think the virus has gotten a hold on her brain-cells that are now a bit dysfunctional. The poor woman.
The day I ran up to arrest her convulsions was when I noticed the characteristic dark patches of what was then my suspicion and now obviously Kaposi Sarcoma - a malignant Tumour that is common to many AIDS patients. Then, it could well have been scars from allergic insect-bites. This is very doubtful now as Kaposi's is very much certain to be the case.
She's since been discharged and sent for H.I.V. confirmatory tests.
Wednesday, July 30, 2008
Hysterical Patient On Admission . . Post-Operative Bands and Adhesions . . Ovarian Cyst
July 30th
I discharged the Herniorraphy/Hydrocelectomy patient today. He still walked funny, his scrotal sac still baggy from the over-stretch, off and on, of over twenty years. Like a pregnant woman's abdomen that shrinks to normal size after delivery, so will his big scrotum.
The man grinned when I informed him so. I smiled back within me.
The Hysterical patient admitted few days back and who "convulsed", has remained sedated ever since and calm when she arouses a bit.
I began tailing off her medication today. We shall see how she fairs by tomorrow.
July 3oth
A patient, let's call her Mrs B, who I admitted about a week ago with a nagging lower abdominal pain, is quite better today.
After 3 previous Casarean Sections and an Appendectomy, my working diagnosis as I admitted her was Post-operative Intra-abdominal Adhesions.
Occassionally, long after extensive intra-abdominal surgery, the intra-abdominal organs may get loosely attached by cobweb-like fibrous strands or even stronger "bands" - These are Intra-abdominal Bands and Adhesions, and they may cause abdominal pains.
My diagnosis may have been wrong however, for a scan revealed a medium-sized Ovarian Cyst. This was the likely cause of her lower abdominal pains. A more thorough check by our Gynaecologist/Obstetrician, had pointed to the cyst.
He did a bi-manual vaginal examination. By placing two fingers of his right gloved hand to the side of the cervix inside the vagina, and the fingers of his free left hand pressed-down on that same side atop her lower abdomen, and then finally both hands made to approach each other (one inside the vagina and the other outside), the buggy mass of an ovarian cyst will be felt.
Because these ovarian cysts pop-up only to sometimes disappear spontaneously (They rupture), we had decided to simply watch and see while she was placed on medication.
I discharged the Herniorraphy/Hydrocelectomy patient today. He still walked funny, his scrotal sac still baggy from the over-stretch, off and on, of over twenty years. Like a pregnant woman's abdomen that shrinks to normal size after delivery, so will his big scrotum.
The man grinned when I informed him so. I smiled back within me.
The Hysterical patient admitted few days back and who "convulsed", has remained sedated ever since and calm when she arouses a bit.
I began tailing off her medication today. We shall see how she fairs by tomorrow.
July 3oth
A patient, let's call her Mrs B, who I admitted about a week ago with a nagging lower abdominal pain, is quite better today.
After 3 previous Casarean Sections and an Appendectomy, my working diagnosis as I admitted her was Post-operative Intra-abdominal Adhesions.
Occassionally, long after extensive intra-abdominal surgery, the intra-abdominal organs may get loosely attached by cobweb-like fibrous strands or even stronger "bands" - These are Intra-abdominal Bands and Adhesions, and they may cause abdominal pains.
My diagnosis may have been wrong however, for a scan revealed a medium-sized Ovarian Cyst. This was the likely cause of her lower abdominal pains. A more thorough check by our Gynaecologist/Obstetrician, had pointed to the cyst.
He did a bi-manual vaginal examination. By placing two fingers of his right gloved hand to the side of the cervix inside the vagina, and the fingers of his free left hand pressed-down on that same side atop her lower abdomen, and then finally both hands made to approach each other (one inside the vagina and the other outside), the buggy mass of an ovarian cyst will be felt.
Because these ovarian cysts pop-up only to sometimes disappear spontaneously (They rupture), we had decided to simply watch and see while she was placed on medication.
Monday, July 28, 2008
Week Starter - The Ward Rounds . . Hernia/Hydrocele, Post-Operative Recovery . . Delusion/Hysteria . . Convulsion - Fits . . High Fever
July 28th
Monday morning ward-rounds were mine to conduct.
I went about them with some of the nursing staff.
I observed that certain notable patients such as the 12 year old with the Enteritis, had over the weekend been discharged and replaced by new cases.
Our Hernia/Hydrocele case seemed to be fairly recovering post-operatively, today being the 6th day.
I later settled down at the out-patients clinic.
I admitted this woman who acted demented, not saying a word to me as I tried to engage her. This was after she walked into my consulting room all by herself.
She was brought to hospital by a colleague of hers who would later act as the informant, and later joined by the patient's older and younger siblings who had been called.
At one point during the information gathering, she became slightly aggitated and confused-looking, never uttering a word.
A widow of 2 years who lives with her kids, the oldest being 13 years, she had exhibited a mild trait of delusion for which she had been seen by a doctor 3 weeks back.
Shortly after she had been confined to the female ward, I had to rush upstairs when she began to throw a fit.
My boss however was of the notion that the convulsions may have been part and parcel of the diagnosed Hysteria.
In any case I started her on a full work-up. More of her later.
July 26th, July 27th
Stayed indoors all through my off-duty weekend. Did a lot of planning in my head.
I'm evolving the details of a venture soon to be launched and embarked on.
It's secret. I may tell it here, later.
Oh yeah, our staff nurse/midwife called me out of my week-end reverie on Sunday, to review her sister in-law whom Dr Larry had admitted with a High Fever.
The same staff nurse/mid-wife who had a difficult first child-birth. She has since resumed duty, back from her maternity leave.
She didn't hide her frustration with her sister in-law for haven earlier on refused medical attention when her condition could then sooner have been salvaged.
I think she said something of the sort that would suggest her sister in-law rather prefering to cling soley unto her faith.
Monday morning ward-rounds were mine to conduct.
I went about them with some of the nursing staff.
I observed that certain notable patients such as the 12 year old with the Enteritis, had over the weekend been discharged and replaced by new cases.
Our Hernia/Hydrocele case seemed to be fairly recovering post-operatively, today being the 6th day.
I later settled down at the out-patients clinic.
I admitted this woman who acted demented, not saying a word to me as I tried to engage her. This was after she walked into my consulting room all by herself.
She was brought to hospital by a colleague of hers who would later act as the informant, and later joined by the patient's older and younger siblings who had been called.
At one point during the information gathering, she became slightly aggitated and confused-looking, never uttering a word.
A widow of 2 years who lives with her kids, the oldest being 13 years, she had exhibited a mild trait of delusion for which she had been seen by a doctor 3 weeks back.
Shortly after she had been confined to the female ward, I had to rush upstairs when she began to throw a fit.
My boss however was of the notion that the convulsions may have been part and parcel of the diagnosed Hysteria.
In any case I started her on a full work-up. More of her later.
July 26th, July 27th
Stayed indoors all through my off-duty weekend. Did a lot of planning in my head.
I'm evolving the details of a venture soon to be launched and embarked on.
It's secret. I may tell it here, later.
Oh yeah, our staff nurse/midwife called me out of my week-end reverie on Sunday, to review her sister in-law whom Dr Larry had admitted with a High Fever.
The same staff nurse/mid-wife who had a difficult first child-birth. She has since resumed duty, back from her maternity leave.
She didn't hide her frustration with her sister in-law for haven earlier on refused medical attention when her condition could then sooner have been salvaged.
I think she said something of the sort that would suggest her sister in-law rather prefering to cling soley unto her faith.
Friday, July 25, 2008
Finger-Nail, Surgical Removal . . Blind-Ending Neck Of Womb (Cervix).
July 25th
Woke up in a rush this morning. I was running late and It isn't decent keeping patients waiting at the out-patients clinic.
There was no one waiting as I walked the short corridor to my consulting room.
Soon enough they began to arrive.
A young lady had a bad finger-nail and this had been so for about a year now.
Very soon, I took the lady's hand and wedged a scissor blade deeply into the nail-bed of the affected finger. I was a little suprised that the lady was able to watch calmly as the scissor blade played around, wedged in-between finger-nail and nail-bed. Of course she felt no pain whatsoever, but still I thought her incapable of baring the sight, as would most patients.
A local anaesthetic that I had injected around the base of the finger had deadened it to all pain.
"Thank you" she said when I was finally done, and then left.
July 25th
Dr Akindele and I observed a lady's cervix through a speculum inserted into her vagina for that very purpose. It wasn't a normal picture that we saw.
This cervix had no opening.
Dr Akindele had ensured she came for this examination during her menstruation so as to directly observe through which aperture she had usually flowed.
Our observation was revealing.
She lay in the lithotomy position on one of the delivery couches in the labour room as we peered through the illuminated vaginal speculum. We inspected and then soon found the abnormal aperture in her blind-ending womb. It was at the posterior aspect of the cervix and somewhere at the level of the intenal os. Quite abnormal.
It could have been congenital (from birth). Or it could have been acquired following a 5 months illegal abortion carried out years ago when she was eighteen.
Correcting the problem may not however be too technically difficult, the matter resting squarely on the shoulders of our Gynaecologist to whom she has promptly been referred.
Woke up in a rush this morning. I was running late and It isn't decent keeping patients waiting at the out-patients clinic.
There was no one waiting as I walked the short corridor to my consulting room.
Soon enough they began to arrive.
A young lady had a bad finger-nail and this had been so for about a year now.
Very soon, I took the lady's hand and wedged a scissor blade deeply into the nail-bed of the affected finger. I was a little suprised that the lady was able to watch calmly as the scissor blade played around, wedged in-between finger-nail and nail-bed. Of course she felt no pain whatsoever, but still I thought her incapable of baring the sight, as would most patients.
A local anaesthetic that I had injected around the base of the finger had deadened it to all pain.
"Thank you" she said when I was finally done, and then left.
July 25th
Dr Akindele and I observed a lady's cervix through a speculum inserted into her vagina for that very purpose. It wasn't a normal picture that we saw.
This cervix had no opening.
Dr Akindele had ensured she came for this examination during her menstruation so as to directly observe through which aperture she had usually flowed.
Our observation was revealing.
She lay in the lithotomy position on one of the delivery couches in the labour room as we peered through the illuminated vaginal speculum. We inspected and then soon found the abnormal aperture in her blind-ending womb. It was at the posterior aspect of the cervix and somewhere at the level of the intenal os. Quite abnormal.
It could have been congenital (from birth). Or it could have been acquired following a 5 months illegal abortion carried out years ago when she was eighteen.
Correcting the problem may not however be too technically difficult, the matter resting squarely on the shoulders of our Gynaecologist to whom she has promptly been referred.
Tuesday, July 22, 2008
A Herniorrhaphy Performed.. A Hydrocele Found Incidentally.
July 22nd
Dr Nsisi performed a Herniorrhaphy this night and I assisted. A Herniorrhaphy is the surgery done to repair a Hernia, of which the commonest is the Inguino-scrotal Hernia.
This is the type that we performed. The man has been living with it for over twenty years, it being at the Reducible stage. In other words it would collapse back spontaneously, off and on, or the patient would push it back himself. So we say then that it is a Reducible Hernia.
I talk about a Hernia collapsing back. This is possible when you understand that a Hernia is an abnormal protrusion of organs (usually a part of the intestine) outwards, through a weak point on the wall surrounding the cavity within which the organ is found. The abdominal cavity and the abdominal wall, in this case.
I'll give a clear and common example. Children with big navels. It is a part of the intestine that pushes out through a "hole" found just above the navel area. So we call it a Para-umbilical Hernia. Umbilicus is the navel as you may know.
So this man has been carrying about for twenty something years a Right-sided Reducible Inguino-scrotal Hernia. It protruded on and off into the right side of the scrotal sac through a weak area known as the inguinal canal.
This inguinal canal area is exactly the point where we performed the Hernial repair or Herniorrhaphy, after pushing back the loop of intestines found.
Incidentally we found that he equally had a Hydrocele and so a Hydrocelectomy was concomitantly done. More medical jargon, I'm afraid.
Dr Nsisi performed a Herniorrhaphy this night and I assisted. A Herniorrhaphy is the surgery done to repair a Hernia, of which the commonest is the Inguino-scrotal Hernia.
This is the type that we performed. The man has been living with it for over twenty years, it being at the Reducible stage. In other words it would collapse back spontaneously, off and on, or the patient would push it back himself. So we say then that it is a Reducible Hernia.
I talk about a Hernia collapsing back. This is possible when you understand that a Hernia is an abnormal protrusion of organs (usually a part of the intestine) outwards, through a weak point on the wall surrounding the cavity within which the organ is found. The abdominal cavity and the abdominal wall, in this case.
I'll give a clear and common example. Children with big navels. It is a part of the intestine that pushes out through a "hole" found just above the navel area. So we call it a Para-umbilical Hernia. Umbilicus is the navel as you may know.
So this man has been carrying about for twenty something years a Right-sided Reducible Inguino-scrotal Hernia. It protruded on and off into the right side of the scrotal sac through a weak area known as the inguinal canal.
This inguinal canal area is exactly the point where we performed the Hernial repair or Herniorrhaphy, after pushing back the loop of intestines found.
Incidentally we found that he equally had a Hydrocele and so a Hydrocelectomy was concomitantly done. More medical jargon, I'm afraid.
Monday, July 21, 2008
Urticaria: A Follow-Up.
July 21st
The infertile couple returned with the story that the rash came back the next day following the consultation. It had vanished shortly after the Hydrocortisone injection had been given, only for it to begin to creep back that same evening, finally becoming worse than before over the week-end.
I asked about usage of the steroid tablets prescribed to which she affirmed a correct usage.
I was shocked to discover next that she had rubbed a concoction of local herbs cooked in palm oil well unto her skin. This she had done the day after their consultation with me. No wonder then that the rash had become redder and angry-looking. She had caused matters to go worse by her own hands.
I let her know I was slightly irritated by this development. In response, her husband showed slight impatience towards me, and he an educated man.
I calmly wrote the same prescription and some more. I added antibiotics, ordinarily not found in prescriptions for Urticaria. She was now getting feverish, afterall.
July 19th and 20th
Week-end off-duty. My boss will be back in town, Monday.
I've acquired a digital means of getting snapshots that I can then add to these notes. I need to work-out how to go about this without breaching my patients' trust as regards confidentiality concerns and common decency.
The infertile couple returned with the story that the rash came back the next day following the consultation. It had vanished shortly after the Hydrocortisone injection had been given, only for it to begin to creep back that same evening, finally becoming worse than before over the week-end.
I asked about usage of the steroid tablets prescribed to which she affirmed a correct usage.
I was shocked to discover next that she had rubbed a concoction of local herbs cooked in palm oil well unto her skin. This she had done the day after their consultation with me. No wonder then that the rash had become redder and angry-looking. She had caused matters to go worse by her own hands.
I let her know I was slightly irritated by this development. In response, her husband showed slight impatience towards me, and he an educated man.
I calmly wrote the same prescription and some more. I added antibiotics, ordinarily not found in prescriptions for Urticaria. She was now getting feverish, afterall.
July 19th and 20th
Week-end off-duty. My boss will be back in town, Monday.
I've acquired a digital means of getting snapshots that I can then add to these notes. I need to work-out how to go about this without breaching my patients' trust as regards confidentiality concerns and common decency.
Obstructive Uropathy . . . Rectal Examination . . . Intravenous Pyelography . . . Flu.
July 18th
I had a middle-aged male yesterday, referred from his company clinic. His problem was difficulty in micturating. He would get to a convenience whenever he feels the urge to pass urine but then finds that he needs to wait for many seconds to lapse before the urine out-flow can actually begin. There usually is some straining on his part to achieve a good stream.
Obviously he has some degree of obstruction anywhere along the urinary out-let. Could be a Urethral Stricture or a disease pathology of the Prostate gland.
I had to do a full physical examination of the abdomen. This included a "digital" examination. This is a physical assessment per rectum (or a PR), in which the right index finger of the gloved hand, is inserted deeply into the rectum via the anus, in a certain deft maneouvre.
I went ahead, informed and prepared him on my couch and then executed this maneouvre, thus acertaining the nature of the rectal mucosa as well as the prostate gland, all in one sweep of that index finger.
My findings were normal. His rectal mucosa seemed free from any gross pathology and the prostate gland appeared the usual way.
Of course such an examination cannot in itself create a definite, informed opinion. And so I sent him off to do an intravenous pyelograghy - these are radiological studies - amongst other medical tests and investigations.
July 18th
A couple entered my consulting room with their ill toddler. The mum was visibly expectant of a new baby while the "sick" child didn't look so, at all.
As I made the inquiries as to what exactly the problem was, the child played around the room happily.
The dad looked well-groomed and quite the successful family man, all in his mannerisms.
As I examined his little girl, I engaged him conversationally, inquiring what line of business he was into. He was an Accountant in a well known firm.
We talked about the state of the Nigerian capital market. I wrote a prescription for the child while I informed them of this medical blog, writing down for them the web-site and joking that I just might make an entry about their visit if not for anything significant but to mention how healthy-looking I found their daughter to be.
She was indeed chubby and playful. I think it was a minor case of flu that she had.
I had a middle-aged male yesterday, referred from his company clinic. His problem was difficulty in micturating. He would get to a convenience whenever he feels the urge to pass urine but then finds that he needs to wait for many seconds to lapse before the urine out-flow can actually begin. There usually is some straining on his part to achieve a good stream.
Obviously he has some degree of obstruction anywhere along the urinary out-let. Could be a Urethral Stricture or a disease pathology of the Prostate gland.
I had to do a full physical examination of the abdomen. This included a "digital" examination. This is a physical assessment per rectum (or a PR), in which the right index finger of the gloved hand, is inserted deeply into the rectum via the anus, in a certain deft maneouvre.
I went ahead, informed and prepared him on my couch and then executed this maneouvre, thus acertaining the nature of the rectal mucosa as well as the prostate gland, all in one sweep of that index finger.
My findings were normal. His rectal mucosa seemed free from any gross pathology and the prostate gland appeared the usual way.
Of course such an examination cannot in itself create a definite, informed opinion. And so I sent him off to do an intravenous pyelograghy - these are radiological studies - amongst other medical tests and investigations.
July 18th
A couple entered my consulting room with their ill toddler. The mum was visibly expectant of a new baby while the "sick" child didn't look so, at all.
As I made the inquiries as to what exactly the problem was, the child played around the room happily.
The dad looked well-groomed and quite the successful family man, all in his mannerisms.
As I examined his little girl, I engaged him conversationally, inquiring what line of business he was into. He was an Accountant in a well known firm.
We talked about the state of the Nigerian capital market. I wrote a prescription for the child while I informed them of this medical blog, writing down for them the web-site and joking that I just might make an entry about their visit if not for anything significant but to mention how healthy-looking I found their daughter to be.
She was indeed chubby and playful. I think it was a minor case of flu that she had.
Friday, July 18, 2008
Urticaria - Allergic Skin Reaction Characterised By Weals. . Pseudocyesis
July 18th
My boss is out of town. That leaves the boss's wife (Dr Mrs.), Dr Nsisi, Dr Akindele, Dr Larry, Dr Ojelade (The Dentist) and I, to run the hospital.
That's not counting the Nursing staff, the Optometrist, the Labroratory Technologists, the Radiographer and all other cadre that run the other hospital departments, day in day out.
Ours is in fact a Medical Centre, somewhere in the heart of Lagos in Nigeria. And today, we had a run of out-patients as is usually the case.
A noteworthy case was that of a lady, accompanied by her husband, who entered my consulting room looking aggitated. The reason for her discomfort was soon evident - Urticarial rashes all over her body.
These are very itchy weals that appear on the skin surface in their characteristic manner, caused by an allergic reaction within the body. The allergen was soon deciphered upon further inquiry - She had used a branded toilet soap, popular for its skin-fading action, hours before the allergic reaction started.
More interesting about this consultation was the worrisome fact that this couple had remained childless for eight years until now. The husband announced this to me while cautioning me to consider what drugs I shall be prescribing, on account of the safety of his unborn baby.
Quickly I inquired about date of last menstruation and confirmatory pregnancy tests that may have been done. The response that followed, I've known only too well over the years.
Pseudocyesis. It turned out to be just this. It is a strong but largely unfounded belief by a female, of the existence of a pregnancy that is not. Occuring usually when a pregnancy is extremely desired for, It often proves difficult convincing the other party otherwise.
Shortly following, a pelvic scan and a blood pregnancy test showed their belief as false.
I sooner encouraged them to resume the gynaecology consultations. This they had attended compliantly four years ago, to no avail. I keyed in with them on the truism of owning faith. So much so now, to enable exploitation of all that medical aid can continue to offer.
A shot of hydrocortisone 100mg intravenously, followed with tablets prednisolone, had started to cure her of her allergy even before they returned with the scan and test results.
My boss is out of town. That leaves the boss's wife (Dr Mrs.), Dr Nsisi, Dr Akindele, Dr Larry, Dr Ojelade (The Dentist) and I, to run the hospital.
That's not counting the Nursing staff, the Optometrist, the Labroratory Technologists, the Radiographer and all other cadre that run the other hospital departments, day in day out.
Ours is in fact a Medical Centre, somewhere in the heart of Lagos in Nigeria. And today, we had a run of out-patients as is usually the case.
A noteworthy case was that of a lady, accompanied by her husband, who entered my consulting room looking aggitated. The reason for her discomfort was soon evident - Urticarial rashes all over her body.
These are very itchy weals that appear on the skin surface in their characteristic manner, caused by an allergic reaction within the body. The allergen was soon deciphered upon further inquiry - She had used a branded toilet soap, popular for its skin-fading action, hours before the allergic reaction started.
More interesting about this consultation was the worrisome fact that this couple had remained childless for eight years until now. The husband announced this to me while cautioning me to consider what drugs I shall be prescribing, on account of the safety of his unborn baby.
Quickly I inquired about date of last menstruation and confirmatory pregnancy tests that may have been done. The response that followed, I've known only too well over the years.
Pseudocyesis. It turned out to be just this. It is a strong but largely unfounded belief by a female, of the existence of a pregnancy that is not. Occuring usually when a pregnancy is extremely desired for, It often proves difficult convincing the other party otherwise.
Shortly following, a pelvic scan and a blood pregnancy test showed their belief as false.
I sooner encouraged them to resume the gynaecology consultations. This they had attended compliantly four years ago, to no avail. I keyed in with them on the truism of owning faith. So much so now, to enable exploitation of all that medical aid can continue to offer.
A shot of hydrocortisone 100mg intravenously, followed with tablets prednisolone, had started to cure her of her allergy even before they returned with the scan and test results.
Thursday, July 17, 2008
Time-Out. . Medical Blog Maintainance
May 23rd - July 17th
Hello, folks. You may have noticed hitherto, entries in this medical blog that lagged behind by two months or so. Well, those were my entries made before I pitched my tent here at Google's blogger and they in fact constitute all of the documented accounts of my day-to-day routine at work that I have so far penned down any where.
Events encountered at work between May 23rd and July 17th, were not put down on record unfortunately. I spent that period working as usual, organizing personal matters and then eventually re-launching my medical diary here on blogger.
Tomorrow, I shall commence entries in this blog that would reflect my updated schedule of events at work, current within a 48 hour period lag.
Today July 17th, by the way, was the usual out-patient drill.
Hello, folks. You may have noticed hitherto, entries in this medical blog that lagged behind by two months or so. Well, those were my entries made before I pitched my tent here at Google's blogger and they in fact constitute all of the documented accounts of my day-to-day routine at work that I have so far penned down any where.
Events encountered at work between May 23rd and July 17th, were not put down on record unfortunately. I spent that period working as usual, organizing personal matters and then eventually re-launching my medical diary here on blogger.
Tomorrow, I shall commence entries in this blog that would reflect my updated schedule of events at work, current within a 48 hour period lag.
Today July 17th, by the way, was the usual out-patient drill.
Wednesday, July 16, 2008
Prolonged, Obstructed Labour With Foeto-Maternal Distress . . Emergency Caesarean Section . . UEFA Champions League Final
May 22nd
You make an incision first on the skin, and then further incisions on each subsequent layer until the final one is made on the uterus (womb). Quickly the baby is extracted and the fast-bleeding edges of the uterus is clamped, here and there.
You hear the new-born crying its head off as you deftly suture the gash on the womb, reassured now that the baby and mother should be quite safe. . .
Such was the scenerio 3 hours ago, as I performed yet another Emergency Caesarean Section with Dr Larry assisting. The indication being foeto-maternal distress in a Prolonged, Obstructed labour.
Only down-side was, Dr Larry and I not getting to see the UEFA Champions league final match-up between Chelsea FC and Manchester United - Just a little joke.
You make an incision first on the skin, and then further incisions on each subsequent layer until the final one is made on the uterus (womb). Quickly the baby is extracted and the fast-bleeding edges of the uterus is clamped, here and there.
You hear the new-born crying its head off as you deftly suture the gash on the womb, reassured now that the baby and mother should be quite safe. . .
Such was the scenerio 3 hours ago, as I performed yet another Emergency Caesarean Section with Dr Larry assisting. The indication being foeto-maternal distress in a Prolonged, Obstructed labour.
Only down-side was, Dr Larry and I not getting to see the UEFA Champions league final match-up between Chelsea FC and Manchester United - Just a little joke.
Tuesday, July 15, 2008
Death In Advanced Tetanus.. Intra-Uterine Foetal Death.. Emergency Caesarean Section
May 9th
We lost the patient with advanced Tetanus. She died yesterday; so sad.
Tetanus. Quite a deadly disease when treatment is delayed and the disease is at the advanced stage. The causative organism is a bacterium, Clostridium Tetani, that abounds in the soil and found in rusted iron. Apparently, the poor woman had had a locally done pedicure to her foot that resulted later into an infected wound. This would be the obvious source of entry into her system, of the deadly bacterium.
Today also, we sadly lost a baby just before birth, and during labour. The cause of death can only be speculated here at best and its determination is subject to the degree to which intra-partum foetal monitoring and management is carried out at our centre. So, to what degree is intra-partum foetal monitoring and management carried out in this hospital where I work, you may well ask. I would say without elaborating in detail, that the standards could much be improved upon.
We averted another possible intra-uterine death through the intervention of an emergency Caesarean Section that I performed, with the surgical instruments barely sterilized!
Really bad week.
We lost the patient with advanced Tetanus. She died yesterday; so sad.
Tetanus. Quite a deadly disease when treatment is delayed and the disease is at the advanced stage. The causative organism is a bacterium, Clostridium Tetani, that abounds in the soil and found in rusted iron. Apparently, the poor woman had had a locally done pedicure to her foot that resulted later into an infected wound. This would be the obvious source of entry into her system, of the deadly bacterium.
Today also, we sadly lost a baby just before birth, and during labour. The cause of death can only be speculated here at best and its determination is subject to the degree to which intra-partum foetal monitoring and management is carried out at our centre. So, to what degree is intra-partum foetal monitoring and management carried out in this hospital where I work, you may well ask. I would say without elaborating in detail, that the standards could much be improved upon.
We averted another possible intra-uterine death through the intervention of an emergency Caesarean Section that I performed, with the surgical instruments barely sterilized!
Really bad week.
Monday, July 14, 2008
Tetanus At Deadly Stage.. And A Nurse Is Happy
May 6th
A female patient with Tetanus is on admission in the female ward. She is already having frequent, muscular spasms. Very deadly at this stage of the disease, I might add.
Our Staff Nurse/Mid-wife who had a difficult first-time delivery last week, I circumcised her baby boy today.
She was one very happy nurse, let me tell you.
A female patient with Tetanus is on admission in the female ward. She is already having frequent, muscular spasms. Very deadly at this stage of the disease, I might add.
Our Staff Nurse/Mid-wife who had a difficult first-time delivery last week, I circumcised her baby boy today.
She was one very happy nurse, let me tell you.
Sunday, July 13, 2008
Today On The Out-Patient Clinic Consultations
May 2nd
Today on the Campaign trail . . . Oops!
Don't mind me. It is not as if I follow Barack Obama every where he goes campaigning. I follow his campaign on the web most nights, though. I like the guy.
Today on my Out-patient clinic consultations . . . Patients take turns coming in. They sit down then I begin to decipher what manner of ailment they have, quite often a daunting task for lack of adequate communication skills on their part. Eventually they leave when they are done with me only for the next patient to resume the challenge.
I wish sometimes that I were on any presidential campaign trail, for want of a little excitement on the job.
Today on the Campaign trail . . . Oops!
Don't mind me. It is not as if I follow Barack Obama every where he goes campaigning. I follow his campaign on the web most nights, though. I like the guy.
Today on my Out-patient clinic consultations . . . Patients take turns coming in. They sit down then I begin to decipher what manner of ailment they have, quite often a daunting task for lack of adequate communication skills on their part. Eventually they leave when they are done with me only for the next patient to resume the challenge.
I wish sometimes that I were on any presidential campaign trail, for want of a little excitement on the job.
Saturday, July 12, 2008
H.I.V. Status Discrimination. . Bad Obstetric History. . Elective Caesarean Section
May 1st
Didn't go to work today. Sorry, I ought to have said "yesterday". It's gone past mid-night already.
April 30th
Me, big-hearted? I'd rather believe I was only doing my job, Shamsa, in empathising with the patient's plight. I assume we both are refering to the H.I.V. patient who eventually got the job. Our labroratory had confirmed same status. This was then conveyed by the hospital to the company, after the young lady and I had decided she would rest all hope upon the outcome of her meeting with a certain member of the company's PR team whom she had earlier on planned to see, thus relying entirely on his sense of fairness.
Her hopes had not been dashed, so she had informed me via SMS, days after. I was glad for her.
Today, I have circumcisions aplenty.
. . And, 3 lollipops popped!
April 29th
As I walked away from the Staff nurse I had gone to fetch in the female ward for yet another Caesarean Section, a pretty but sullen-faced patient on the far bed to my right, beckoned on me. She began to remind me of time past when she needed my help to enable her scale past a Pre-employment medical assessment, while at the same time being H.I.V. positive.
I responded to her greeting as I recalled that past event, while noticing how tired and strained her eyes seemed. Dr Larry had admitted her earlier in the day for Malaria, she said.
She then attempted to thank me again for the other time. As I left her side, I remembered she eventually got the job.
It's a sad thing how in this part of the world, individuals seeking employment are discriminated against by virtue of their HIV status. They usually don't get considered for employment. Of course this is against internationally acceptable standards, so much so that their rights' get readily violated when HIV screening is carried out without their knowledge and hence, without their express consent.
To this effect, coniving hospitals such as the one I work in, share equal guilt!
Caesarean Section was later done successfully. Indication: Precious Baby. This in Obstetrics, refers to the situation whereby a woman has had in the past, a particularly bad obstetric history, with no baby alive till date. A Caesarean section then offers the most viable and risk-free mode of delivery that ensures the safety of the much desired baby.
April 28th
I had a bit of a flood of out-patients today. Absolutely nothing of interest happened.
Except that I refused to do a circumcision on account of the fact that the larger-sized device that had gone missing(stolen by one of the staff, to be sure!), is yet to be replaced, and I refused to "manage" and make do with the crude, "guillotine" method. The smaller-sized device wouldn't fit around this neonates weighty penis.
My protest bore results. A replacement is to be made available, Wednesday morning.
Didn't go to work today. Sorry, I ought to have said "yesterday". It's gone past mid-night already.
April 30th
Me, big-hearted? I'd rather believe I was only doing my job, Shamsa, in empathising with the patient's plight. I assume we both are refering to the H.I.V. patient who eventually got the job. Our labroratory had confirmed same status. This was then conveyed by the hospital to the company, after the young lady and I had decided she would rest all hope upon the outcome of her meeting with a certain member of the company's PR team whom she had earlier on planned to see, thus relying entirely on his sense of fairness.
Her hopes had not been dashed, so she had informed me via SMS, days after. I was glad for her.
Today, I have circumcisions aplenty.
. . And, 3 lollipops popped!
April 29th
As I walked away from the Staff nurse I had gone to fetch in the female ward for yet another Caesarean Section, a pretty but sullen-faced patient on the far bed to my right, beckoned on me. She began to remind me of time past when she needed my help to enable her scale past a Pre-employment medical assessment, while at the same time being H.I.V. positive.
I responded to her greeting as I recalled that past event, while noticing how tired and strained her eyes seemed. Dr Larry had admitted her earlier in the day for Malaria, she said.
She then attempted to thank me again for the other time. As I left her side, I remembered she eventually got the job.
It's a sad thing how in this part of the world, individuals seeking employment are discriminated against by virtue of their HIV status. They usually don't get considered for employment. Of course this is against internationally acceptable standards, so much so that their rights' get readily violated when HIV screening is carried out without their knowledge and hence, without their express consent.
To this effect, coniving hospitals such as the one I work in, share equal guilt!
Caesarean Section was later done successfully. Indication: Precious Baby. This in Obstetrics, refers to the situation whereby a woman has had in the past, a particularly bad obstetric history, with no baby alive till date. A Caesarean section then offers the most viable and risk-free mode of delivery that ensures the safety of the much desired baby.
April 28th
I had a bit of a flood of out-patients today. Absolutely nothing of interest happened.
Except that I refused to do a circumcision on account of the fact that the larger-sized device that had gone missing(stolen by one of the staff, to be sure!), is yet to be replaced, and I refused to "manage" and make do with the crude, "guillotine" method. The smaller-sized device wouldn't fit around this neonates weighty penis.
My protest bore results. A replacement is to be made available, Wednesday morning.
Friday, July 11, 2008
A Mid-wife's Very Own First Child-Birth
April 26th
Finally, our usually dutiful Staff Nurse, had a safe delivery of her own.
It sure was a difficult delivery, with a resultant perineal tear that was promptly repaired. A baby boy weighing 3.3 kg.
Many times it is not so much of the baby's weight or head size that results in the difficulty but rather, the manner in which the head presents in relation to the bony pelvic out-let. A Brow presentation, for example, offers a larger diameter, and so on.
Actually I'm off-duty today. I'm told by my colleague that another potentially difficult delivery is currently "incubating" in the labour room.
By the way, I live within the hospital confines.
Finally, our usually dutiful Staff Nurse, had a safe delivery of her own.
It sure was a difficult delivery, with a resultant perineal tear that was promptly repaired. A baby boy weighing 3.3 kg.
Many times it is not so much of the baby's weight or head size that results in the difficulty but rather, the manner in which the head presents in relation to the bony pelvic out-let. A Brow presentation, for example, offers a larger diameter, and so on.
Actually I'm off-duty today. I'm told by my colleague that another potentially difficult delivery is currently "incubating" in the labour room.
By the way, I live within the hospital confines.
Huge, Inflammed Appendix. . . Nuliparous Labour. . Breech vs. Cephalic. . Pueperal Sepsis. . Road Traffic Accident With Collar Bone Dislocation
April 25th
Assisted Dr Nsisi in the Theatre today. I haven't seen an inflammed appendix that huge and ready to rupture in a long while. Surgery was a success, thank goodness.
One of our very own; a Staff Nurse/Midwife, is in labour even as I type this entry. She is nuliparous, and so, her first time in labour.
She had a lucky break ealier at 8 months gestation when the baby turned, changing its position from the breech posture, to the cephalic one. She very likely would have required surgery otherwise.
Now in labour, she appears edgy. It's proving to be a difficult one; painfully slow in its progress.
April 24th
The female with the macerated twin who was delivered through Caesarean Section 3 weeks ago, was rushed in today as an emergency, bleeding severely, per vaginam. Diagnosis was Pueperal, Post-operative Sepsis. It appeared that the powerful antibiotic cover she ought to have received post-operatively, were inadequately administered . . .
She unavoidably was transfused, by the way, with two pints of blood.
She pulled-through; yes.
April 23rd
Radiology (x-ray) studies of this male Road Traffic Accident victim, clearly showed he had diasthesis of the right Sterno-clavicular joint. Ouch! This must be really painful, seeing as the Sterno-clavicular joint is an immobile, fixed joint - The one between the collar bone and the chest bone.
In any case I consider him lucky as he suffered no Head Injury. Suffice is to say that he shall be visited by our Orthopaedic surgeon, haven admitted him for stabilization.
April 22nd
Off-duty today.
Pregnancy Induced Hypertension (P.I.H.) . . Health Maintainance Organisations
(H.M.O.s) . . M.D. Maverick . . Caesarean Section
April 21st
I promised details about the PIH case admitted yesterday. But first, today, quickly - I Caesarean Sectioned a woman with Dr Larry assisting. Her induced labour just wasn't going anywhere; wasn't progressing. It was her first. Both mum and baby are stable. A baby girl.
Now, back to yesterday when I hinted that the admitted PIH case took an unexpected turn.
Well, she opted to, and discharged herself same yesterday! You wonder why; I know.
It's my maverick M.D. whom I shall one day fully introduce. Now, this patient is of the H.M.O. stock and by that virtue is not a cash-paying patient. H.M.O, remember? - Health Maintainance Organizations. They act as go-betweens, between hospitals and patients. Yet many hospital M.D.s, mine not excluded, insist that they get ripped-off by them.
My boss insisted that she pays the hospital, cash. She refused, called her huband and left for another H.M.O. hospital, so she told me.
April 20th
I'm on call duty this weekend, all of 48 hours. The Ante-natal clinic's today.
The Obstetrician admits a woman in advanced pregnancy, who has developed Pregnancy Induced Hypertention (P.I.H.).
However, this admission takes a strange turn of events. I'll bring you details, later.
Assisted Dr Nsisi in the Theatre today. I haven't seen an inflammed appendix that huge and ready to rupture in a long while. Surgery was a success, thank goodness.
One of our very own; a Staff Nurse/Midwife, is in labour even as I type this entry. She is nuliparous, and so, her first time in labour.
She had a lucky break ealier at 8 months gestation when the baby turned, changing its position from the breech posture, to the cephalic one. She very likely would have required surgery otherwise.
Now in labour, she appears edgy. It's proving to be a difficult one; painfully slow in its progress.
April 24th
The female with the macerated twin who was delivered through Caesarean Section 3 weeks ago, was rushed in today as an emergency, bleeding severely, per vaginam. Diagnosis was Pueperal, Post-operative Sepsis. It appeared that the powerful antibiotic cover she ought to have received post-operatively, were inadequately administered . . .
She unavoidably was transfused, by the way, with two pints of blood.
She pulled-through; yes.
April 23rd
Radiology (x-ray) studies of this male Road Traffic Accident victim, clearly showed he had diasthesis of the right Sterno-clavicular joint. Ouch! This must be really painful, seeing as the Sterno-clavicular joint is an immobile, fixed joint - The one between the collar bone and the chest bone.
In any case I consider him lucky as he suffered no Head Injury. Suffice is to say that he shall be visited by our Orthopaedic surgeon, haven admitted him for stabilization.
April 22nd
Off-duty today.
Pregnancy Induced Hypertension (P.I.H.) . . Health Maintainance Organisations
(H.M.O.s) . . M.D. Maverick . . Caesarean Section
April 21st
I promised details about the PIH case admitted yesterday. But first, today, quickly - I Caesarean Sectioned a woman with Dr Larry assisting. Her induced labour just wasn't going anywhere; wasn't progressing. It was her first. Both mum and baby are stable. A baby girl.
Now, back to yesterday when I hinted that the admitted PIH case took an unexpected turn.
Well, she opted to, and discharged herself same yesterday! You wonder why; I know.
It's my maverick M.D. whom I shall one day fully introduce. Now, this patient is of the H.M.O. stock and by that virtue is not a cash-paying patient. H.M.O, remember? - Health Maintainance Organizations. They act as go-betweens, between hospitals and patients. Yet many hospital M.D.s, mine not excluded, insist that they get ripped-off by them.
My boss insisted that she pays the hospital, cash. She refused, called her huband and left for another H.M.O. hospital, so she told me.
April 20th
I'm on call duty this weekend, all of 48 hours. The Ante-natal clinic's today.
The Obstetrician admits a woman in advanced pregnancy, who has developed Pregnancy Induced Hypertention (P.I.H.).
However, this admission takes a strange turn of events. I'll bring you details, later.
Thursday, July 10, 2008
Post-Surgical Wound Dressing.. Circumcision.. Out-Patient Clinic.. Banking Transaction
April 19th
Ordinary day at the out-patient consulting clinic.
Concerning that Reverend gentleman who had his neck tumour removed. Well, the wound is nearly closed and oozing less fluid, ever since we began daily dressing from the time his stitches were removed. Not too suprising though, considering the Tuberculous nature of this surgical wound, at origin.
April 18th
Wet lollipops is how they look like, when infant penises are newly circumcised. Forgot to mention I did two circumcisions the other day.
I use this metal device and this method gives instant results. They finally peep out looking like kiddies lollies.
You should be able to tell by now that I'm a general-duty doctor in this private hospital setting that I'm employed at. I see all manner of cases, only to then refer to our specialists when occassioned.
Today's activities? Ordinary day consulting at the out-patients.
April 17th
Today too, was ordinary. I went to the bank at close of day. I watched the bespectacled cashier as I waited my turn. Not the one I was lined up to be attended to by, but the one to my right, herself equally busy attending to a short line of customers. Nice to look at, she was.
Soon it was my turn. I left promptly after concluding my transaction.
Ordinary day at the out-patient consulting clinic.
Concerning that Reverend gentleman who had his neck tumour removed. Well, the wound is nearly closed and oozing less fluid, ever since we began daily dressing from the time his stitches were removed. Not too suprising though, considering the Tuberculous nature of this surgical wound, at origin.
April 18th
Wet lollipops is how they look like, when infant penises are newly circumcised. Forgot to mention I did two circumcisions the other day.
I use this metal device and this method gives instant results. They finally peep out looking like kiddies lollies.
You should be able to tell by now that I'm a general-duty doctor in this private hospital setting that I'm employed at. I see all manner of cases, only to then refer to our specialists when occassioned.
Today's activities? Ordinary day consulting at the out-patients.
April 17th
Today too, was ordinary. I went to the bank at close of day. I watched the bespectacled cashier as I waited my turn. Not the one I was lined up to be attended to by, but the one to my right, herself equally busy attending to a short line of customers. Nice to look at, she was.
Soon it was my turn. I left promptly after concluding my transaction.
Wednesday, July 9, 2008
Tumour of Fat Origin - A Lipoma.. Tuberculous Neck Swelling.. Anatomical Provocativeness.. Al Capone
April 16th
Removed a lump from a female's neck today. Likely of fat origin - A Lipoma.
Oh, yes. Good news. Remember the other neck swelling? Well, the histology report makes it out to be - I'll spare you the jargon - a Tuberculous neck tumour. Now, that's much more favourable than a Cancer, obviously. He'll live.
By the way, the gentleman is a Reverend, though I suspect it's one of those "ceremonial" types.
April 15th
Boring day managing out-patients . . .
The stitches came out today and the pretty patient discharged. I refer to the Appendectomy case I did 7 days ago.
Truth be told, same way I confessed to Dr Larry, that I quite admire the young lady. That is to say, from a certain anatomically provocative perspective. It goes no further however, for I am sworn to an oath as you well may know. Two oaths in fact, in that same regard, for I am married.
April 13th
I'm still weekending and off-duty. Read all about Al Capone on the web, wow! Real -life drama.Very interesting times those were. Many more web stuff did I do.
Work resumes tomorrow. So does "Secret Notes".
Removed a lump from a female's neck today. Likely of fat origin - A Lipoma.
Oh, yes. Good news. Remember the other neck swelling? Well, the histology report makes it out to be - I'll spare you the jargon - a Tuberculous neck tumour. Now, that's much more favourable than a Cancer, obviously. He'll live.
By the way, the gentleman is a Reverend, though I suspect it's one of those "ceremonial" types.
April 15th
Boring day managing out-patients . . .
The stitches came out today and the pretty patient discharged. I refer to the Appendectomy case I did 7 days ago.
Truth be told, same way I confessed to Dr Larry, that I quite admire the young lady. That is to say, from a certain anatomically provocative perspective. It goes no further however, for I am sworn to an oath as you well may know. Two oaths in fact, in that same regard, for I am married.
April 13th
I'm still weekending and off-duty. Read all about Al Capone on the web, wow! Real -life drama.Very interesting times those were. Many more web stuff did I do.
Work resumes tomorrow. So does "Secret Notes".
Tuesday, July 8, 2008
Routine Caesarean.. Introducing The Introduction Of My Medical Director - An Interesting Personality.
April 12th
Off-duty this week-end. Time to catch-up on other things..
April 11th
Saw a few out-patients then left for Ikoyi to attend to some personal matters.
April 9th
Caesarean Section today went well. Mother and baby-boy are fine.
Remind me to introduce my boss, the Medical Director, to these secret documentations. He quite simply is an interesting individual; a Consultant Neurologist at that.
Off-duty this week-end. Time to catch-up on other things..
April 11th
Saw a few out-patients then left for Ikoyi to attend to some personal matters.
April 9th
Caesarean Section today went well. Mother and baby-boy are fine.
Remind me to introduce my boss, the Medical Director, to these secret documentations. He quite simply is an interesting individual; a Consultant Neurologist at that.
Monday, July 7, 2008
Acute Appendicitis. . Unwarranted Sick-Leave Certificate
April 9th
Appendectomy performed successfully on my young patient, this p.m. No other noteworthy occurrence today. Booked-down a Caesarean Section - I shall be assisting Dr Nsisi tomorrow on this one.
O.k, a confession. I was solicited for an unwarranted sick-leave paper by this pretty female patient of mine; a Banker. Not the least bit ill, she only needed the time-off to travel out of the country for a brief, personal business dealing.
I obliged!
April 8th
Appendectomy performed successfully on my young patient, this p.m. No other noteworthy occurrence today. Booked-down a Caesarean Section - I shall be assisting Dr Nsisi tomorrow on this one.
O.k, a confession. I was solicited for an unwarranted sick-leave paper by this pretty female patient of mine; a Banker. Not the least bit ill, she only needed the time-off to travel out of the country for a brief, personal business dealing.
I obliged!
April 8th
A surgical incision through 7 layers of anterior abdominal wall, is what I shall be making on this young female patient tomorrow at Theatre,who suffers Acute Appendicitis.
This would bring me into her abdominal cavity, where upon I shall begin the manoeuvre of removing her infected, troubling Appendix.
Sunday, July 6, 2008
Labour Enhanced.. Fatat Twin Pregnancy.. Emergency Caesarean Section
April 7th
It was confirmed at Theatre two weeks ago that the second twin of this unfortunate mother was macerated. Our first incline came an hour earlier when it was noticed, a life-less little hand gone all blue and cold, protruding out of the mother's vagina. The other twin was alive.
The poor mum had been on admission about a week or so prior to the incident, as a case of Twin pregnancy at 8 months gestation in a once previous Caesarean Section, and with one twin persistently in Transverse lie.
Post-operatively, both mother and surviving twin have continued to stay in good health.
April 6th
Women have achieved normal delivery more readily, so I have observed on record, when labour is allowed to progress unaided for as long a time as possible.
Such is the case when at advanced labour, say 8 - 9cm cervical dilatation, a patient arrives at the hospital haven laboured at home for quite a while, and will soon be delivered of her baby with relatively more ease.
The baby then seems to fall out, plop!
The mother is usually left with little or no vulval tear or without the need for an episiotomy.
It was confirmed at Theatre two weeks ago that the second twin of this unfortunate mother was macerated. Our first incline came an hour earlier when it was noticed, a life-less little hand gone all blue and cold, protruding out of the mother's vagina. The other twin was alive.
The poor mum had been on admission about a week or so prior to the incident, as a case of Twin pregnancy at 8 months gestation in a once previous Caesarean Section, and with one twin persistently in Transverse lie.
Post-operatively, both mother and surviving twin have continued to stay in good health.
April 6th
Women have achieved normal delivery more readily, so I have observed on record, when labour is allowed to progress unaided for as long a time as possible.
Such is the case when at advanced labour, say 8 - 9cm cervical dilatation, a patient arrives at the hospital haven laboured at home for quite a while, and will soon be delivered of her baby with relatively more ease.
The baby then seems to fall out, plop!
The mother is usually left with little or no vulval tear or without the need for an episiotomy.
Saturday, July 5, 2008
Menstrual Abnormalities,Enlarged Scrotum,Fractured Collar Bone..?Fatal Neck Tumour.
April 4th
This 4 year-old boy was brought in as an emergency haven been pelted inside a moving vehicle driven by the mum. He was quite shaken-up but rather stable.
His mum was a little apprehensive but mostly quiet.
The boy however, had a bruising with tenderness around the left shoulder that was confirmed through X-rays to be a Fracture of the left collar bone.
Well, I applied a figure-of-eight bandage around those little shoulders.
It's noteworthy here that this accident could have been prevented by the usage of a child-restraining device.
Bad mum, I must say.
April 4th
He may well survive afterall, this gentleman whose right-sided neck tumour we removed surgically 10 days back and who had his stitches out today.
Was it a Tuberculous growth or a Cancer? The histology report of tissue samples taken and sent, will determine its exact nature. The report is expected anytime soon.
I discharged the patient with the left scrotal swelling today. There was a hitherto unseen springiness to his gait.
April 2nd
I steadily plunged the needle into this man's enlarged, tender left scrotum. I had expected to see altered blood fill-up the 20cc syringe.
It was dry.
The original diagnosis of Epididimorchitis must have been the correct one. His case file told me he had been admitted the previous day; his diagnosis wavering from Acute Epididimorchitis, to Scrotal Haematoma, and then back.
Promptly, the medical management of his ailment was changed accordingly.
April 1st
This young, female patient seemed to know very little concerning her menstrual period. I find this typical amongst women I see during my out-patient consultations. Details such as cycle duration and timeliness, show them at a loss. And God forbid they happen to get two seperate flows in a single month, to them it signifies an abnormality that requires promt attention! They make the matter fuzzier than it ought to had it been they understood their cycles better.
I sent her off to run the inevitable pelvic scan.
I began dozing off at some point between seeing patients today, no thanks to what I have often tagged as "overnight-browsing hang-over".Good enough, Dr Larry was doing a terrific job clearing the out-patients.
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