Sunday, May 27, 2007

Re: Gunshot Injury

Many are made to believe doctors don't have emotions. It's understandable if you too think so. The training is such that even when you feel something, rather than let it go by crying out loud , one tends to supress it as the teaching is, " if doctors cries, what then dose the patient do?'.

This evening i really for the first time in this practice felt like crying for a patient. Not that this is the first patient being considered foran amputation of the leg. Well i have already let the cat outta the bag. Here is how it goes. In the last two posts on this topic i gave a chronological presentation of what our fellow Nigerian is suffering from lack of proper medical facilities and organization.

Just like we predicted, the patient is now a case of Planned amputation.
The orthopeadics have come and the procedure explained to him. But as you will expect, the young man has refused amputation. The danger here is that, the longer it takes him to come to terms with the fact that he has to let go one of his legs (right leg for that matter), the better for him. The leg as i speak has already become gangrenous and if infected, it could spread upwards and what could have been a below knee amputation, could become above knee.

Meanwhile we are all very happy in the unit, that despite not being able to procure heparin, we didn't have problem Deep Venous Thrombosis. He seems to be doing well with clexane. Meanwhile, I hope and pray he makes up his mind on time. what the hell is happening to our health care in this country. This blog is fast becoming some sort of SOS stuff. Keep your fingers crossed. I'll keep you updated.

Tuesday, May 22, 2007

Gunshot Injury: Nigerian Doctors Dilemma

Our patient with Gun shot injury is anything but unlucky. Though at this time it’s still too early to say whether or not his limb will recover fully, you might still be interested in knowing how he’s doing. Well like I last said, we finally were able to take him into the theatre at about 12.30am. It was a long night for an operation that lasted till 5.30am. No member of the unit had a wink of sleep the whole night. If you are reading this you might to tempted to think I’m lying but it’s true. Nigerian doctors are not what you have always heard. They are dedicated. As a fact they a over worked and under paid. If you have ever had a bad encounter with any, it is definitely this frustration that sometimes is expressed as poor doctor-patient relationship.

My indefatigable Chief headed the team that explored our patient’s grin to ascertain the extent f damage and salvage the limb if possible. By the time we went in, we found that the femoral artery at the level of the inguinal ligament was totally severed by the bullet. Our major task then was to arrest the bleeding that had started gushing out from the proximal end of the artery.

Next task was to repair the artery. The surgeon had to take a graft from the other leg to repair the blood vessel. This failed because; in the process of handling the graft it became traumatized. This is a situation that would have been avoided if the hospital had microscopes for microscopic surgeries. The suture material is not meant to touch the intimae of the vessel as it predisposes to embolization with its own dire consequences.

So we had to make do with prosthetic device made from tetrafluroethylene, a material that is made to have the same properties as an artery. Note that this material was not provided by the hospital but by my chief-According to him, he’s not going to ask the patient to pay as they patient can never finish paying him. The usual charity medicine we practice in Nigeria.

Now back to the surgery! We replace the destroyed section of the artery with this device and at about 5.30am we were through and all won out. Hoping that what has been done show positive result. The result was drastic, better that what we expected. As at yesterday, power in the affected limb has increased. The limb getting warm, except the ankle and the foot. But so far we happy it didn’t get as bad as we thought. Now in order to save him, he has to be on heparin (an anti-coagulant). But guess what there no single drop of heparin in the hospital is. In fact not even a single drop is available in town. We need to make special arrangement for someone to get it out of town and by then our fear would have already happened. Besides, the patient can’t even afford blood transfusion how much more, sending for drugs out of town. We have to settle for a not so good alternative- Clexane. I’ll keep you updated on what happens next. This is just a tip of the iceberg the things people go through in a totally bastardized system.

What could have otherwise been an easy ride for everyone has become complicated situation due to bad laws and neglect of the health system. Doctors do have their short comings, but the season Nigerians are going abroad for treatment of malaria is due to things like this. Heparin is a drug a hospital shouldn’t lack. But our teaching hospital has no heparin

Thursday, May 17, 2007

Gun Shot Injury

If you have read the previous write up, show you must be expecting something on smoking.Well that's a series and i intend to continue.

Meanwhile something interesting just happened in the hospital today and i think i should let us know about it and take precautions and maybe also do something about the health care system in this country. The law that doctors shouldn't treat a gunshot case until a police report is presented, or that patients gunshot patients should first of all report at the police station before seeking help in the hospital is causing us a lot.

This senerio is however a recurring decimal in the system. Before i forget, i want to let you share in this sordid stroy.

A 24 year old male patient who was involved in a gunshot incident on his right hip was brought to the hospital yesterday. He was ofcourse seen by the doctor on call and admited to be tranfered to the ward. Today when the consultant came for a ward round his attention was drawn to this patient.

To cut a long story shot, the signs elicited showed that, there has been a damage to the major artery supplying blood to the limb (The femoral artey). And while the patient was trying to get police report, apart from bleeding so much, there has been ischemia of the right lower limd as blood has seized to flow into it for upto 24hrs.

The implications of this is that, this young 24 year old fellow with a very bright future has lost his limb all because, nothing was done for him in the first 6 hours of this event. The limb still looks very good but truth is that, it will get bad, worse and worst with time. Simply, the limb is dead. This man may loose is his limbs for the rest of his life. What can we do with draconian laws in this country?

Tuesday, May 15, 2007

What do you know about smoking? (2)

Effect of Smoking On different Organ systems

The habit of smoking can actually affect various organs of the body. Starting from the top, i will take them accordingly. Smoking will affect, the Central and peripheral nervous systems(the brain, and the nerves), The Respiratory system (lungs), the Gastrointestinal tract(the stomach and other bowels), the urogenital system(eg. prostate in males), The reproductive system(as in pregancy), the Cadiovascular system(the heart, veins and arteries).

Let's take the Nervous system.

The Nicotine belongs to a group of hard drugs with a common characteristic of Addiction. Nicotine can be used in refined form and in regulated amounts to produce drugs which can be used in hospitals for specific treatment of some conditions ..Cocaine is even used aldo in this manner. When this is done, care is taken avaoid dependence. Dependence is said to have occured in a patient when he will no longer do well except when a particular drug is administered. In this case he usually demand for the said drug. The patient has now become adicted. It no longer easy to stop at this time because stopping abruptly could lead to very severe consequences though not worse than the result of not stopping. What is called withdrawal syndrome.

One in two long-term smokers will die from a smoking related illness. The dangers of smoking have been studied and analyzed for years. The detrimental effect of smoking on people’s health and their activities is now public knowledge. The vast majority of smokers say they want to stop. Why don’t they?

It’s hard to stop smoking even when you know intellectually that you should. That’s because the habit of smoking is not maintained by an intellectual decision. Smoking is a habit and an addiction to nicotine. Smoking is self-perpetuating-your body craves the powerful stimulant to which it has become accustomed.

Hypnosis works at eliminating the desire to smoke, whether it is from identification or replacement, the two principle reasons for smoking.

Identification is when the smoker indulges in the habit because he admires (or associates) with others who smoke, i.e. parents, peers, or celebrities. Identification smoking is the most common and the easiest to eliminate.

Replacement is when smoking takes the place of a previous habit (such as overeating), is used to replace something that is missing, (such as companionship, love, acceptance, self-esteem, security, independence), or when it fills a void created by anxiety or boredom. Replacement smokers often receive sensual gratification from smoking. They enjoy the feeling of the cigarette in their mouth or the taste of the tobacco. For cigar and pipe smokers, the act of lighting often becomes a ritual.

For both types of smokers, smoking is both a physical and mental process. So to be effective, the stop-smoking program must address both aspects.

You can see then that all this is now a phychiatric disorder and needs treatment. Though we in Africa regard phyciatric hospitals as a place for only the crazy man running naked on the street. Cigarette smokers will benefit from the services of a trained psychiatrist.This write up for today is limited to it's effect in the central nervous system.

Tommorrow, i will talk about effect os cigarette on peripheral nerves and the how to treat (stop smoking) this mental process that overwhelms smokers.

Monday, May 14, 2007

What do you know about smoking? (1)

I'll first like to know what you know about smoking. Wait a minute. I don't mean the different styles of puffing the smake or handling the butt. What i mean is what effects of smoking do you really know?

I'm sure you must have heard severally that smokers are liable to die young or that according to the Surgeon general smoking can cause cancer. That's vague enough and i don't intend to continue on that part. I'll go further than that to tell you that truely smokers are liable to die young. I will also unravel or demistify medical mumbo jumbos which are of no use to you. (Except ofcourse you are as insane as I am).

This is the first of my posts and it's going to be a roller-coaster of smoking expose'. You sure should be able to scare you enough to make you stop smoking if you are a smoker and if you are not, enough to keep you from trying it). This illustrations will be all with pictures.

Sunday, May 13, 2007

Free Health Clinic Online

Today I start a new blog. I have done a couple of things online but not really in my area of specialty which is medicine. Haven't spent 8 years studying medicine i was so expectant when I finally graduated. However i am so bored stiff by the nature of my work. Not just by the fact that i keep doing the same thing everyday and not expected to change routine but also by the fact that I am not expected to use my iniative. The hierachy in a teaching hospital is such that one has to take approval for everything he dose. In essence i might probably have to take permission to prescibe paracetamol.

Against this back drop i decided to seek solace doing things i expected to bring some flavour into my day-to-day existence. But now after setting up a couple of 'successful' websites and working as admin, I now want to run a blog where readers who have questions on their health can ask them freely and openly and also get very sincere answers.

My experience shows me that Africans unlike Americans ans Europeans no little or nothing anout their health. In today's world, good health can only be guaranteed through adequate information.

I therefore intend to allow anonymous posts so that if you have a question to ask you can do so and no one will ever know that's you talking. I know what part confidentlity plays in gaining the trust of patients.

While i will not be giving any form of treatment on this blog, health issues shall be exhaustively discussed and you shall always have to make your decision at the end.

I know that together we can improve the awareness of Nigerian's and Africans as a whole on issues bordering on their health. So i shall start posting on this blog as soon as possible as I have listed out a couple of topics i would be talking about. In the meantime if you have topics you think i should give priority and discuss first, please do not fail to indicate. However i can start talking your questions immediately.

Your comments, questions and suggestions are welcome.