Today i realized my parent's mortality and it hit hard. It hit me that what is actually going into my dad's mouth has the propensity to kill him and save his life, and it all depends on an equation tested on rats and now performed on humans which trials have shown should go according to plan. Well what happens when one of the constituents of the equation lags? It hit me as i counseled my mother about what she needs for bone health, that outside of God's own intervention, she would have been wheelchair bound and maybe we would never be having this conversation...
It's easy when you are a doctor in training to be focused on getting work done rather than enjoying the moments at work; to be focused on giving information rather than ensuring information is received; to pay attention to the check list of things to send patients home with, rather than involve myself with the change in their life with what I have given. But here I am, dealing with the medical knowledge as it applies to the people I love, and the only defence I have is to doctor it up in other not to cry...
On thanksgiving day today, I am thankful for the reminder that life is fleeting. I am thankful for the blessing to sit in the same room with my parents after 3 yrs, even if it means I get to be their doctor and daughter all it once. And I am thankful that God intervenes and doesn't wait for us to thank him only for that which we remember. I am thankful for you Lord.
Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
Thursday, November 24, 2011
Monday, December 27, 2010
Mass and nodules
My first consult today was with a 73 year old previously healthy man. The last time he was sick was 4 years ago when he had stomach pain from an ulcer. It happened on Christmas day. It was so bad he had to go see a doctor. Then for 4 years, nothing. Until this Christmas when after eating a wonderful meal with family and friends, the pain came back. It got so bad that he couldn't sleep and by 4am this morning he decided to come in and see the doctor.
We took some blood and ran some tests. It turns out that he not only has an enlarged thyroid that has moved his wind pipe over to one side of his chest, he also has enlarged lymphs nodes in his chest, and abdomen, almost down to his pelvis. And then his liver is acting up and so his liver enzymes are high. He used to be a heavy drinker over 30 years ago. He also has a mass in his lungs.
What struck me was he was so grateful the pain was gone and he could now sleep. He has no idea that he probably just ate the last meal he will enjoy for a long long time. And he probably just slept the last few hours of worry free sleep.
The next consult I just kind of helped with. The woman is 52 years old. She has had swelling and pain in her right breast for 3 months. She has also had over 20 lb weight loss in that same time and has had chills off and on. The pain got bad enough that she came into the clinic to see the doctor. We saw and examined her and reported back to the senior resident. He looked over all her labs, her history and then her imaging studies. Then he went into the room to speak with and examine her as well. While he examined her he found big lymph nodes in her right axilla. That was enough to give the most likely diagnosis. He sat down looked her straight in the eye and then said to her "you probably have cancer." Her response? "I know something was wrong but I've been praying for 3 months that Jesus would take it away. What am I supposed to do now?" His voice cracked as he went on to explain what the next steps would be. She was already in another world...
Mass and nodules, two terrible words that can change the course of one's life forever. What are we supposed to do now?
We took some blood and ran some tests. It turns out that he not only has an enlarged thyroid that has moved his wind pipe over to one side of his chest, he also has enlarged lymphs nodes in his chest, and abdomen, almost down to his pelvis. And then his liver is acting up and so his liver enzymes are high. He used to be a heavy drinker over 30 years ago. He also has a mass in his lungs.
What struck me was he was so grateful the pain was gone and he could now sleep. He has no idea that he probably just ate the last meal he will enjoy for a long long time. And he probably just slept the last few hours of worry free sleep.
The next consult I just kind of helped with. The woman is 52 years old. She has had swelling and pain in her right breast for 3 months. She has also had over 20 lb weight loss in that same time and has had chills off and on. The pain got bad enough that she came into the clinic to see the doctor. We saw and examined her and reported back to the senior resident. He looked over all her labs, her history and then her imaging studies. Then he went into the room to speak with and examine her as well. While he examined her he found big lymph nodes in her right axilla. That was enough to give the most likely diagnosis. He sat down looked her straight in the eye and then said to her "you probably have cancer." Her response? "I know something was wrong but I've been praying for 3 months that Jesus would take it away. What am I supposed to do now?" His voice cracked as he went on to explain what the next steps would be. She was already in another world...
Mass and nodules, two terrible words that can change the course of one's life forever. What are we supposed to do now?
Wednesday, March 31, 2010
Tears in the RCU
Today I cried with a patient, actually, not with him, but for him, and maybe a little bit for myself also.
72yo male with a history of stroke, high blood pressure, surgery on the left leg for broken tibia. He is an occasional drinker and a 63 pack year smoker. The patient was brought into the ER by ambulance after his wife called 911 because she found him on the floor and he could not tell her how he got there neither could he get up by himself. This was the second fall in three weeks. He was admitted for left sided pneumonia. Admission criteria (you need this to admit a patient for whatever disease and each disease has its own admission criteria) included 'confusion,' fever, age over 65 and shortness of breath. The fact that his chest xray showed what looked to be a picture of pneumonia helped to egg diagnosis in that direction.
During his hospital stay we found that his 'left sided pneumonia' was not pneumonia at all. What had seemed to be 'confusion' on his admission was aphasia due to the stroke he had about 3 yrs back. Unfortunately ER staff could not tell because no one knew his baseline and his wife was not there when he was admitted so it was assumed that he was confused. When we got a hold of her the next day she was able to fill in a lot of blanks in his story. That got rid of one of the admission criteria for pneumonia. In addition, his fever of 100.4 as measured in the ER never resurfaced again so there went another pneumonia admission criteria. His shortness of breath did remain and he remained on oxygen via nasal canula.
In the next few days and after receiving a complete history from his wife (history is so important), his diagnosis was changed to Chronic Obstructive Pulmonary Disease (COPD) exacerbation, and Congestive Heart Failure (CHF) exacerbation. Unfortunately the patient had also started showing signs of dementia which did not help with collecting information from him daily to assess how he was doing and because of his aphasia he was quite difficult to understand. Despite this, he and I established a good rapport; I learned to wait for him to get his sentences out and he learned to be patient with me and repeat himself several times until I finally figured out what he was trying to say. On my part, there was a lot of guess work in between.
In the next few days and after receiving a complete history from his wife (history is so important), his diagnosis was changed to Chronic Obstructive Pulmonary Disease (COPD) exacerbation, and Congestive Heart Failure (CHF) exacerbation. Unfortunately the patient had also started showing signs of dementia which did not help with collecting information from him daily to assess how he was doing and because of his aphasia he was quite difficult to understand. Despite this, he and I established a good rapport; I learned to wait for him to get his sentences out and he learned to be patient with me and repeat himself several times until I finally figured out what he was trying to say. On my part, there was a lot of guess work in between.
Three days into his admission he became unresponsive and was rushed to the MICU where he was intubated and received critical care management. I was distraught the day I heard. This was one week ago.
This week he became alert and responsive and was moved to the Respiratory Care Unit (RCU) and back under the care of the team I was assigned to. When I saw him on Monday I was sad because this once somewhat healthy, rambunctious, "strong man" as he told me himself once, was reduced to tubes, and soft restraints to prevent him from pulling tubes out. Today I held his hand and looked in his eyes and saw how helpless he felt and felt helpless for him. I cried openly, apologizing to him for being such a baby but telling him I hope he gets well soon enough and I'll be praying for him. A few days after that his family agreed to move him to a nursing home as his wife was elderly and did not feel she could take care of him.
My tears in the RCU reminded me that I have not yet become callous to the pain of others and compassion is a way of life, not a just a fleeting moment in the wind.
Please keep him in your prayers.
Tuesday, March 23, 2010
Another mark in history!
After almost a century of healthcare debate in the US,
the journey begins towards Universal Healthcare.
I have to say I think this is one of the most amazing things to happen in US history.
I am hoping it will set a precedence for developing countries like mine,
showing us it is never too late to make necessary changes of things that need to be done!
And will help us realize that it can be done
and yes it will take sacrifice
but human life is always more important than mula (money).
Sunday, March 21, 2010
House Approves Landmark Bill to Extend Health Care to Millions
House Approves Landmark Bill to Extend Health Care to Millions
US of A is finally moving to become a country
whose healthcare 'system' I can begin to respect.
Yay to change,
no matter how painful it may be!
Monday, February 01, 2010
Extra Extra, read all about it!
Study finds focus on abstinence in sex-ed classes can delay sexual activity
By Rob Stein Washington Post Staff Writer
Summary: Teach abstinence in a fair and unbiased way and see what happens.
The result is adolescents, for the most part, choose wisely.
Thank God for knowledge!
Thank God for wisdom!
Thank God for wisdom!
Monday, January 18, 2010
Health Alert!
Reversing itself, FDA expresses concerns over health risks from BPA
- ------------------------------
The Food and Drug Administration (FDA) has reversed its position on
the safety of Bisphenol A (BPA), a chemical found in plastic bottles,
soda cans, food containers and thousands of consumer goods, saying it
now has concerns about health risks... Washington Post
So the bottom line is the FDA approved this chemical for use (it is so prevalent that something like 90% of the US population will have urine test positive for BPA) and this approval was based on questionable research to begin with and now BPA is a health concern. The approval was based on research funded by the Chemical Industry. Dare I say that is a blatant conflict of interest? Also, the FDA approved BPA use despite advice from its own independent science advisers: "The agency was faulted by its own panel of independent science advisers in 2008, which said its position on BPA was scientifically flawed because it ignored more than 100 published studies by government scientists and university laboratories that raised health concerns about BPA."
I don't know what you will take away from this. I personally have always been weary of the FDA because of its approval of certain Pharma products without thorough or unbiased research. Regardless of how you (or I) feel, we need to keep an eye on what happens with this chemical because it will affect our health.
- ------------------------------
The Food and Drug Administration (FDA) has reversed its position on
the safety of Bisphenol A (BPA), a chemical found in plastic bottles,
soda cans, food containers and thousands of consumer goods, saying it
now has concerns about health risks... Washington Post
So the bottom line is the FDA approved this chemical for use (it is so prevalent that something like 90% of the US population will have urine test positive for BPA) and this approval was based on questionable research to begin with and now BPA is a health concern. The approval was based on research funded by the Chemical Industry. Dare I say that is a blatant conflict of interest? Also, the FDA approved BPA use despite advice from its own independent science advisers: "The agency was faulted by its own panel of independent science advisers in 2008, which said its position on BPA was scientifically flawed because it ignored more than 100 published studies by government scientists and university laboratories that raised health concerns about BPA."
I don't know what you will take away from this. I personally have always been weary of the FDA because of its approval of certain Pharma products without thorough or unbiased research. Regardless of how you (or I) feel, we need to keep an eye on what happens with this chemical because it will affect our health.
Wednesday, December 30, 2009
MALARIA, ARTEMISININ RESISTANCE
A ProdMED-mail Post
O'treng village doesn't look like the epicenter of anything. Just off
a muddy rutted-out road, it is nothing more than a handful of
Khmer-style bamboo huts perched crookedly on stilts, tucked among a
tangle of cornfields once littered with deadly land mines. Yet this
spot on the Thai-Cambodian border is home to a form of malaria that
keeps rendering one powerful drug after another useless.
This time, scientists have confirmed the 1st signs of resistance to
the only affordable treatment left in the global medicine cabinet for
malaria: artemisinin.
If this drug stops working, there's no good replacement to combat a
disease that kills one million annually. As a result, earlier this
year [2009], international medical leaders declared resistant malaria
here a health emergency.
"This is not business as usual. It's something really special, and it
needs a real concerted effort," said Dr. Nick White, a malaria expert
at Mahidol University in Bangkok who has spent decades trying to
eradicate the disease from Southeast Asia...
Mosquitoes spread this resistant malaria quickly from shack to shack,
village to village, and eventually country to country...People generate drug resistant malaria when they take too little medicine, substandard medicine or -- as is all too often the case
around O'treng -- counterfeit medicine with a pinch of the real
stuff. Once established, the drug-resistant malaria is spread by
mosquitoes. So one person's counterfeit medicine can eventually spawn
widespread resistant disease.
A recent study out of neighboring Laos found 88 percent of stores
selling artemisinin-based drugs, the same ones scientists are
desperately trying to preserve, were actually peddling fakes. Worse,
nearly 15 percent of the counterfeits were laced with small hints of
artemisinin, which could prompt resistance. The researchers found
indications that some were made in China, feeding smugglers' routes
that snake through Myanmar and into Laos, Thailand, Cambodia and Viet
Nam.
The counterfeits, along with outdated drugs, are jumping continents.
In Africa, where malaria is endemic in 45 countries, the fake drug
industry is thriving. A 2003 World Health Organization survey found
between 20 percent and 90 percent of antimalarials randomly purchased
in 7 African countries failed quality testing, depending on the type
of drug.
WHO and Interpol formed a task force 3 years ago to try to stop
counterfeiters, seizing millions of fake malaria, tuberculosis, HIV
and other pills in Southeast Asia and Africa. But officials say the
work is only as good as the countries' legal systems.
With no new treatments in the pipeline, normally reserved scientists
are quick to use words like "disaster" or "catastrophe" when asked
what might happen if they don't contain the disease that's ravaging
this boy... before it spreads to Africa. There, malaria already kills an
estimated 2000 kids daily.
Source: The Associated Press cited by CTV [edited]
<http://www.ctv.ca/servlet/
Photos From:
NationalGeographic.com
O'treng village doesn't look like the epicenter of anything. Just offa muddy rutted-out road, it is nothing more than a handful of
Khmer-style bamboo huts perched crookedly on stilts, tucked among a
tangle of cornfields once littered with deadly land mines. Yet this
spot on the Thai-Cambodian border is home to a form of malaria that
keeps rendering one powerful drug after another useless.
This time, scientists have confirmed the 1st signs of resistance to
the only affordable treatment left in the global medicine cabinet for
malaria: artemisinin.
If this drug stops working, there's no good replacement to combat a
disease that kills one million annually. As a result, earlier this
year [2009], international medical leaders declared resistant malaria
here a health emergency.
"This is not business as usual. It's something really special, and it
needs a real concerted effort," said Dr. Nick White, a malaria expert
at Mahidol University in Bangkok who has spent decades trying to
eradicate the disease from Southeast Asia...
Mosquitoes spread this resistant malaria quickly from shack to shack,village to village, and eventually country to country...People generate drug resistant malaria when they take too little medicine, substandard medicine or -- as is all too often the case
around O'treng -- counterfeit medicine with a pinch of the real
stuff. Once established, the drug-resistant malaria is spread by
mosquitoes. So one person's counterfeit medicine can eventually spawn
widespread resistant disease.
A recent study out of neighboring Laos found 88 percent of stores
selling artemisinin-based drugs, the same ones scientists are
desperately trying to preserve, were actually peddling fakes. Worse,
nearly 15 percent of the counterfeits were laced with small hints of
artemisinin, which could prompt resistance. The researchers found
indications that some were made in China, feeding smugglers' routes
that snake through Myanmar and into Laos, Thailand, Cambodia and Viet
Nam.
The counterfeits, along with outdated drugs, are jumping continents.
In Africa, where malaria is endemic in 45 countries, the fake drug
industry is thriving. A 2003 World Health Organization survey found
between 20 percent and 90 percent of antimalarials randomly purchased
in 7 African countries failed quality testing, depending on the type
of drug.
WHO and Interpol formed a task force 3 years ago to try to stop
counterfeiters, seizing millions of fake malaria, tuberculosis, HIV
and other pills in Southeast Asia and Africa. But officials say the
work is only as good as the countries' legal systems.
With no new treatments in the pipeline, normally reserved scientists
are quick to use words like "disaster" or "catastrophe" when asked
what might happen if they don't contain the disease that's ravaging
this boy... before it spreads to Africa. There, malaria already kills an
estimated 2000 kids daily.
Source: The Associated Press cited by CTV [edited]
<http://www.ctv.ca/servlet/
Photos From:
NationalGeographic.com
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