tag:blogger.com,1999:blog-48936677730994089632024-03-14T02:30:30.912-07:00Amanzimtotiamanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.comBlogger55125tag:blogger.com,1999:blog-4893667773099408963.post-67597534227645554382010-11-25T08:54:00.000-08:002010-11-25T10:51:13.120-08:00Tables turned<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgC2-6EatRSxZtfk9-fmr7TuWfv29yD7HeaFtMR25Q1zpDxuSQPyt4qT0UqNNgy6nbI1ldWOChElSwnS2CeD46hmMZfpT8XJBbCnd4IDVn1mlZJNfcDeJw1uA0LIgth8L_wVKlXT91O-hs/s1600/red_blue_pill1.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 300px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgC2-6EatRSxZtfk9-fmr7TuWfv29yD7HeaFtMR25Q1zpDxuSQPyt4qT0UqNNgy6nbI1ldWOChElSwnS2CeD46hmMZfpT8XJBbCnd4IDVn1mlZJNfcDeJw1uA0LIgth8L_wVKlXT91O-hs/s400/red_blue_pill1.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5543561698290555122" /></a><br /><div><br /></div><div><br /></div>I saw this patient who complained of heartburn. I gave her standard treatment and told her that if she did not respond, we would refer her for gastroscopy.<br /><br />Months later I saw her again. This time she complained that the medication she was on was making her feel sick. She was very aggressive and accusative, as some patients get when they feel you are not giving them the right treatment. I checked and saw that it was metronidazole. Now, drinking alcohol while taking this particular antibiotic makes you feel dreadful, so I asked about alcohol consumption. She immediately denied it and became very defensive. I then asked about her heartburn. She said it wasn't getting any better. I asked about Grand-pa (a headache powder containing aspirin and caffeine) or aspirin use, as abuse of these can cause peptic ulcers. She had previously denied it. This time she paused for a while and then admitted to occasionally using Grand-pa. I starting explaining the link between Grand-pa use and ulcers. She then immediately backtracked and claimed it was actually paracetomol she was using.<br /><br />I told her that we should refer her for gastroscopy and started explaining what it was. At this point she interrupted me and said that she had already had this procedure done. Oh, ok, I thought. I asked what they had found. "They found that I have ulcers" she said. Great, I thought, a diagnosis! "I'm taking tablets", she continued. I sighed on the inside. Usually at about this point my heart sinks because people who start with the statement "I'm taking tablets" often don't know what these tablets are. We usually become entangled in a complicated web of descriptions of size, colour, frequency, shape and formulation. For example: I take half of a small white diamond shaped tablet in the morning, two large round yellow tablets in the morning and at night; and a large blue and white capsule at night. This usually doesn't help me at all because, firstly, I'm not a pharmacist and, secondly, you get alot of small white tablets and alot of large yellow tablets.<br /><br />"Do you know the name of the medicine?" I asked. "No" she said, as expected. "Actually, it is the same colour as your pen" she exclaimed. I looked at it. Coincidentally, it was a Nexium pen given to me by a drug rep. I turned it around to expose the label. "Is this the tablet you're taking?" I asked, showing her the label. "Yes" she declared happily. "But this <span style="font-style:italic;">is</span> a treatment for ulcers" I said surprised. "Are you sure you aren't drinking Grand-pa?" I asked, knowing that this is probably why the Nexium wasn't working. She went quiet and I knew.<br /><br />"You should stop drinking the Grand-pa and you'll get better I said". She smiled a sheepish smile and said "ok".amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com1tag:blogger.com,1999:blog-4893667773099408963.post-12424434750214695062010-05-26T01:50:00.000-07:002011-03-24T00:08:15.176-07:00What's in a name?I collect odd names. I realise now that sounds a bit weird, but having a odd name myself, I think it's fine. Anyway, here are a few odd names I've picked up over a couple of years. They're a mix of patient and non patient names, including waiters, shop attendants, etc. - generally people who wear name tags. No surnames are included.<br /><br />Nappy - this is the non American word for diaper.<br />Surprise - his mom was obviously not expecting him!<br />Simian - maybe mom anticipated he would do alot of monkeying around?<br />Trinity - a cool name if you're a female superhero in an alternative future where machines rule the world.<br />Father - he was named after a Catholic priest. I asked. I don't think his parents realised though that "Father" was his title and not his first name.<br />Girly - must have been the only girl.<br />Pietstraus - Was named after a guy called Piet Straus. I asked.<br />Sakkie - Afrikaans for packet.<br />Icy - either it was very cold when he was born, or he gave his mom the cold shoulder. I think so anyway.<br />Goodboy - self evident. Or maybe wishful thinking.<br />Treazer - should be a character in Harry Potter.<br />Class - was born in a classroom maybe? Maybe his parents thought he had alot of class? Maybe his parents wanted him to become a teacher? Maybe he was named after a guy called Klaas.<br />Million - one in a million maybe?<br />Mongo - it just sounds funny.<br />Ribon - why would you name your child ribbon? Maybe she felt she deserved a blue ribbon for her efforts. I know I did after I gave birth.<br />Staffnes - he was named after the staff nurse who delivered him. hehehe.<br />Saloon - as far as I know we don't even have saloons in South Africa!<br />Wonderful - quite sweet actually.<br />Lickim - hahahahahahaha! Maybe it's supposed to be Likehim.<br />Sycho - maybe he is.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com7tag:blogger.com,1999:blog-4893667773099408963.post-18127808972937331202010-05-24T03:46:00.000-07:002010-05-24T04:29:04.487-07:00PrioritiesSo I see this patient and she's at death's door. She has multiple pathology and needs admission to hospital. I'm pretty sure I can pull her through, given the chance. But will I be given the chance?<br /><br />Her husband has escorted her in and whilst I'm filling in the admission forms, the nursing sister comes to me and says that the husband wants to leave and take his wife with him. I'm flabbergasted. "What's the problem?" I ask. "He needs to go back to work and there's no one but his wife to watch the children" I'm told. I feel relieved. Easily solvable. I'll give him a medical certificate I say: family responsibility. He can't stay even if given a medical certificate, I'm told, because he has already been off of work for three weeks and if he doesn't go back today he'll lose his job. I stop dead in my tracks. "So what has he been doing for the past three weeks?" I want to know. "Why didn't he bring his wife in then?" (I should have known something was up when she claimed that she'd only been sick for 3 days even though she had clearly been sick for quite some time.) "She has been getting treatment from the traditional doctor."<br /><br />At this point I am more than just a little annoyed. The husband comes in. "Why didn't you bring her in when she didn't respond to the sangoma's treatment 2 weeks ago? Or even 1 week ago?" No reply. I struggle to understand what the hell is going on. I know they're not being forthcoming. Why would he refuse help for his wife when she's clearly in a very bad way? But what can I do? The sister calls the social worker to counsel them.<br /><br />I finish the forms and go back to seeing other patients. I go back a short while later to find out what progress we've made. They're gone. "What happended?" I ask the nurse. "They left" she says bluntly. "But why? I ask."<br /><br />The story emerges: The wife was being treated by a sangoma and they were paying good money for this treatment. That morning, before I saw her, they went for another treatment. This time however, they informed the good sangoma that their money had dried up. He then promptly informed them that, on second thought, he could no longer help them, but that she probably needed an HIV test and that there was a good clinic (ours) she could go to where they would "save her life". That's how they ended up with me. Because he had stayed out of work for so long and given the sangoma all his money, however, the husband had gone into a panic about losing his job. At the last minute. So he took his sick wife home to watch the kids, while he went back to work. <br />I could not understand his logic. Who is going to watch the children when she's dead, I wondered.<br /><br />But the more pertinent thing here is the fact that this sangoma preyed on these desparate people. He took their money when he knew he was giving her the wrong treatment.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com4tag:blogger.com,1999:blog-4893667773099408963.post-16632115385061456572009-11-27T08:08:00.000-08:002009-11-29T07:41:00.508-08:00Collateral damageOne of the most difficult things to deal with in the HIV/AIDS epidemic (for me anyway) is its effect on the children. But the disease is not only affecting children through infection and death. It's also leaving behind a staggering amount of orphans.<br /><br />I met a woman who was quite young and had two beautiful, well dressed, well cared for little children. They were well groomed, healthy and happy. "These aren't her own children" I was told (for we did not speak the same language). "They're her sisters' kids". There was a boy who looked to be about 2 or 3 years old and a little girl who looked about one. "Both of their mothers died of AIDS when they were very young and she's been caring for them ever since". They looked very healthy and very well adjusted. Both of them had escaped infection and to them, she was the only mother they knew. They had no memory of their real mothers.<br /><br />Their fathers were still alive, but were not contributing in any way. She had apparently sued both of them for maintenance, but nothing had come of it. She had also applied for help from social services as she was very poor and could barely keep head above water. She had heard nothing from them. There is a social grant available for people taking care of orphans, but this woman did not qualify for it as these children were not technically orphans - their fathers still being alive. Although for all intents and purposes they were. I was astounded. They looked amazingly well. It was clear that this woman was not just taking care of them, but was absolutely devoted to them.<br /><br />But there was more, for years ago another one of her sisters had died, also of an HIV related disease, and this woman had taken in her children as well. They were teenagers now and in high school and were basically able to take care of themselves, so to speak. One of them even had a part time job and was helping out a bit.<br /><br />I did not have words. Here was a woman who was fighting a deadly disease, who had lost all her siblings, who was living on the bread line and who still had enough strength to take the best possible care of these little kids. And these children were clearly very happy. Carefree in fact. I commended her. She was doing an amazing job with them. She gave a sheepish smile.<br /><br />I referred her to a social worker who managed to get her an appointment with legal aid and with another social worker who worked in her area. All I could do was try to help her fight this disease that had already decimated her family.<br /><br />I wondered what treatment her sisters had sought, if any. I wondered if their efforts to get treatment had been thwarted by the South African government.<br /><br />But she was getting treatment now and hopefully it wasn't too late.<br /><br />She was such an impressive person. She was one of those heroes walking around in plain clothing.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com1tag:blogger.com,1999:blog-4893667773099408963.post-64420015332622728632009-11-24T22:20:00.000-08:002009-11-24T08:48:11.592-08:00Sleep, glorious sleepLast night my daughter slept through the night. She has been depriving me of sleep for 1 year and 1 month now. She still wakes up in the middle of the night, every night. Except last night. Now, I am not under the delusion that she will sleep through the night every night or even most nights from now on, because my three year old son still wakes up at night at least twice a week. But at least he goes back to sleep almost immediately. Anyway, the point is, this morning I woke up feeling refreshed and that doesn't happen very often.<br /><br />It got me thinking about calls: and lack of sleep and how exhausted I used to be as an intern. And how it's nothing compared to how exhausted I am as a mother!<br /><br />I hate calls. Fortunately I don't do calls anymore, but having to get up 2 to 3 times a night to feed a baby or put a toddler back to bed is like doing calls in itself, except you're on call every night and every night you're guaranteed to be called out and it's certain that you will be called out more than once. And even though you don't actually have to get dressed and go to the hospital, it is constant and by far more exhausting. As soon as you fall asleep again, the "beeper" goes off yet again. Normally, on a call like that it would be better not to sleep at all, but you don't really have that option as a mother. And sleeping when the baby sleeps... well, that's a laugh! And there's no such thing as sleeping in or taking a nap either. the kids will have none of that!<br /><br />But I think the problem is more interrupted than litttle sleep. I think interrupted sleep is much worse than getting even a solid 4 hours. When we went to Las Vegas recently, my mom babysat for us and so, although I was jetlagged, when I slept, it was uninterrupted and so when I woke up, I wasn't exhausted. I felt rejuvenated even. It was strange because I'd kind of become used to the sleep deprivation.<br /><br />But I'm back to being a walking zombie now. Hopefully not for much longer though.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com2tag:blogger.com,1999:blog-4893667773099408963.post-60837634272307032722009-09-03T14:32:00.000-07:002009-09-06T10:00:49.947-07:00SurgeXperiences 305: This Is Africa<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi24GUzC9T5yXde57wTHA2rir3MPF_uLMXhQJqoRBI_r-Wkr0396r9MRLvObmYjiAdjTF9NyANZioqzGh5et49hi_Ow_hhEzIog9yOMRIuoQkZrfqLB1pCHeTKW79OMbdvs8HVItN-Etkc/s1600-h/africa.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 285px; height: 185px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi24GUzC9T5yXde57wTHA2rir3MPF_uLMXhQJqoRBI_r-Wkr0396r9MRLvObmYjiAdjTF9NyANZioqzGh5et49hi_Ow_hhEzIog9yOMRIuoQkZrfqLB1pCHeTKW79OMbdvs8HVItN-Etkc/s400/africa.jpg" alt="" id="BLOGGER_PHOTO_ID_5378367898018462946" border="0" /></a><span style="color: rgb(255, 102, 0);font-size:130%;" >Welcome to Africa for this 305th edition of SurgeXperiences:</span>
<br /><span style="color: rgb(255, 153, 0);">we have some great articles for this edition of the fortnightly surgical blog carnival...</span>
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<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMbgpOXmutfd3FWV9lPZcu7UpVck_oZqlKaTYVTMKHOz26N0img3JrnLDvv0UM6yLo1A1BB-wu8Z5d0sASkxp_X9456OjkKVdpClUrcyyvaQmyoEJMkAsfQCbng9L0CYqAYFsv0yXsoDE/s1600-h/african+hospital.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 200px; height: 128px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMbgpOXmutfd3FWV9lPZcu7UpVck_oZqlKaTYVTMKHOz26N0img3JrnLDvv0UM6yLo1A1BB-wu8Z5d0sASkxp_X9456OjkKVdpClUrcyyvaQmyoEJMkAsfQCbng9L0CYqAYFsv0yXsoDE/s400/african+hospital.jpg" alt="" id="BLOGGER_PHOTO_ID_5378357972438189074" border="0" /></a>Sid Schwab of <a style="color: rgb(153, 153, 153);" href="http://surgeonsblog.blogspot.com/">Surgeonsblog</a> writes about the current health care debate in the USA and points out how <a style="color: rgb(102, 51, 255);" href="http://surgeonsblog.blogspot.com/2009/08/bureaucrats.html">private healthcare insurers do not provide cover for what you really need it for</a>. They are businesses after all and a "Guy's gotta make a buck, right?" We all know that insurance companies will try anything to get out of paying out, but some of these examples of exclusions are ridiculous. Dr Schwab states: "The question is, does the current system work and is it sustainable without significant change? In my view, the answer is clearly no."
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<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 10"><meta name="Originator" content="Microsoft Word 10"><link rel="File-List" href="file:///C:%5CUsers%5Cuser%5CAppData%5CLocal%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:applybreakingrules/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:usefelayout/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:SimSun; panose-1:2 1 6 0 3 1 1 1 1 1; mso-font-alt:宋体; mso-font-charset:134; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 680460288 22 0 262145 0;} @font-face {font-family:"\@SimSun"; panose-1:2 1 6 0 3 1 1 1 1 1; mso-font-charset:134; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 680460288 22 0 262145 0;} @font-face {font-family:Mistral; panose-1:3 9 7 2 3 4 7 2 4 3; mso-font-charset:0; mso-generic-font-family:script; mso-font-pitch:variable; mso-font-signature:647 0 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:SimSun;} @page Section1 {size:595.3pt 841.9pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style>In <a style="color: rgb(102, 51, 255);" href="http://surgeonsblog.blogspot.com/2009/08/think-slow.html">another post</a> from Surgeonsblog, Dr Schwab talks about one of the most difficult decisions a surgeon has to face: the decision not to operate. A fitting piece of advice given to one of the commenters by a wise mentor: "not everyone has to have an operation before they die".
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<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnSoiwPwtLR5h3iwfUu36sXc-Gs3yicUUAEOAheoQD6CgmruhUbvWhfSW5CZTDQK_oAIIfzIQANV0_IKNEd3sQwM1GS-2X0CyFLhxjxYWi0a3rxx1-Yhaw7unMLY7foeh5hFpFvQLjj68/s1600-h/women+carrying+water.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 150px; height: 124px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnSoiwPwtLR5h3iwfUu36sXc-Gs3yicUUAEOAheoQD6CgmruhUbvWhfSW5CZTDQK_oAIIfzIQANV0_IKNEd3sQwM1GS-2X0CyFLhxjxYWi0a3rxx1-Yhaw7unMLY7foeh5hFpFvQLjj68/s400/women+carrying+water.jpg" alt="" id="BLOGGER_PHOTO_ID_5378378245543617234" border="0" /></a>Dr Alice from <a style="color: rgb(153, 153, 153);" href="http://cutonthedottedline.wordpress.com/">Cut On The Dotted Line</a><span style="color: rgb(153, 153, 153);"> </span>tells us what it's like to <a style="color: rgb(102, 51, 255);" href="http://cutonthedottedline.wordpress.com/2009/08/29/a-day-in-the-cardiac-icu-part-1/">spend </a><a style="color: rgb(102, 51, 255);" href="http://cutonthedottedline.wordpress.com/2009/08/29/a-day-in-the-cardiac-icu-part-1/">a day in the cardiac ICU</a><a style="color: rgb(102, 51, 255);" href="http://cutonthedottedline.wordpress.com/2009/08/29/a-day-in-the-cardiac-icu-part-1/">.</a> Part 1, only takes us through her morning, but it seems like a full day already! She concludes <a style="color: rgb(102, 51, 255);" href="http://cutonthedottedline.wordpress.com/2009/09/01/a-day-in-the-cardiac-icu-part-2/">here</a>.
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<br /><a style="color: rgb(153, 153, 153);" href="http://rlbatesmd.blogspot.com/">rlbates</a> does an article review on <a style="color: rgb(102, 102, 204);" href="http://rlbatesmd.blogspot.com/2009/09/radiation-therapy-and-breast.html">radiation therapy and breast reconstruction</a>, a very important topic in women's health, the approach to which appears to remain contraversial.
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<br />The ever proliferative story teller <a style="color: rgb(153, 153, 153);" href="http://other-things-amanzi.blogspot.com/">Bongi</a> tells <a style="color: rgb(102, 51, 255);" href="http://other-things-amanzi.blogspot.com/2009/08/sacred-memories.html">a </a><a style="color: rgb(102, 51, 255);" href="http://other-things-amanzi.blogspot.com/2009/08/sacred-memories.html">poignant story </a>about memories and reflection and how one can never really go back; <a style="color: rgb(102, 51, 255);" href="http://other-things-amanzi.blogspot.com/2009/08/tharrr-she-blows.html">a stomach turning story</a> (if a surgeon gags, you know it's gotta be bad!); <a style="color: rgb(102, 51, 255);" href="http://other-things-amanzi.blogspot.com/2009/08/proudly-south-african.html">a very typically South African story</a>; <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmdjjAumk3-wnmFfRVX3c8JiybGVbRYUldYRrqIqnojRC0IaRpB_YRsdRFSxExUMDsnSG_jtm5BXYmjT9V33bg0R22_radC5rqo5HwX0D6zPteW_nlS9iWmVd-orwb6DuZTJlFHlfq2Vg/s1600-h/elephant+on+car.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 213px; height: 176px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmdjjAumk3-wnmFfRVX3c8JiybGVbRYUldYRrqIqnojRC0IaRpB_YRsdRFSxExUMDsnSG_jtm5BXYmjT9V33bg0R22_radC5rqo5HwX0D6zPteW_nlS9iWmVd-orwb6DuZTJlFHlfq2Vg/s400/elephant+on+car.jpg" alt="" id="BLOGGER_PHOTO_ID_5378367925313588210" border="0" /></a>and <a style="color: rgb(102, 51, 255);" href="http://other-things-amanzi.blogspot.com/2009/08/just-because-youre-paranoid-doesnt-mean.html">an absolute must read</a><span style="color: rgb(102, 51, 255);"> </span>about a frightening, surreal experience he had as a student in a maximum security mental institution - or it may have been a scene from a bad zombie movie, I'm not sure ;)
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<br /><a style="color: rgb(192, 192, 192);" href="http://jeffreyleow.wordpress.com/">Jeffrey Leow</a>, looks back on his <a style="color: rgb(204, 102, 204);" href="http://jeffreyleow.wordpress.com/2009/09/03/of-shock-therapy-schizophrenics-and-the-obsssessive-compulsive-medical-student/">psychiatry rotation</a>. It's a very interesting reflection and a worthwhile read.
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<br /><a style="color: rgb(153, 153, 153);" href="http://www.kevinmd.com/blog/">KevinMD </a>talks about <a style="color: rgb(102, 51, 255);" href="http://www.kevinmd.com/blog/2009/08/situs-inversus-and-the-difficulty-of-operating-on-patients-with-reversed-anatomy.html">operating on patients with situs inversus</a><span style="color: rgb(0, 204, 204);">.</span>
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<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitU8R4p9JmxJERSeJD4jOgPEfpkv5ZC023mixkuVstSIL30iL2TmD_ipG7caCLtFicWzWGxziMbcY5XbYMaE_pLDwG0ZEVMTeZLZ0SFuyl9D9-SfSZK3WnuW_TDQUcbUwin5BJjUhNeRw/s1600-h/trauma.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 274px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitU8R4p9JmxJERSeJD4jOgPEfpkv5ZC023mixkuVstSIL30iL2TmD_ipG7caCLtFicWzWGxziMbcY5XbYMaE_pLDwG0ZEVMTeZLZ0SFuyl9D9-SfSZK3WnuW_TDQUcbUwin5BJjUhNeRw/s400/trauma.jpg" alt="" id="BLOGGER_PHOTO_ID_5378357974845619234" border="0" /></a>Shirley Wang of <a href="http://blogs.wsj.com/health"> </a><a style="color: rgb(153, 153, 153);" href="http://blogs.wsj.com/health/">The Wall Street Journal Health blog</a> <a style="color: rgb(102, 51, 255);" href="http://blogs.wsj.com/health/2009/09/01/study-surgeon-experience-doesnt-impact-patient-deaths/">interviews Elliot Haut</a>, the first author of a recent study published in Archives of surgery, which found that a trauma surgeon's experience makes no difference on patients' likelihood of survival. The overall system of care appears to be the important factor. Interesting. Take a look.
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<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEip31gCWEcqtvA8T6xOAtUBtBIpAp65IhTa7i12U-u3J8U6PL7I1jnDYGGACK_LyiBgnwTkoPpvb9PULW6WVQTl17NkQ9vl_6-x6udLsK_PgTcKzB3PUEUe5WjXif545HbW1WifBLRRz3M/s1600-h/sangoma.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 163px; height: 217px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEip31gCWEcqtvA8T6xOAtUBtBIpAp65IhTa7i12U-u3J8U6PL7I1jnDYGGACK_LyiBgnwTkoPpvb9PULW6WVQTl17NkQ9vl_6-x6udLsK_PgTcKzB3PUEUe5WjXif545HbW1WifBLRRz3M/s400/sangoma.jpg" alt="" id="BLOGGER_PHOTO_ID_5378360193835508338" border="0" /></a>Sheepish from <a style="color: rgb(153, 153, 153);" href="http://papermask.blogspot.com/">The Paper Mask</a>, talks about the growing discipline of <a style="color: rgb(102, 51, 255);" href="http://papermask.blogspot.com/2009/08/botox-bollocks.html">Cosmetic Medicine</a> and the lack of regulation and standards in the industry. I've always found it interesting that people are very careful to take their cars, appliances, electronics, etc to an accredited dealer only, yet will take major risks with their health and lives by going to somebody who may or may not be properly qualified or even somebody who has no qualifications or accreditation at all, when your health is the very thing you should never mess around with. Boggles my mind.
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<br /><div style="text-align: left;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd_TMpCj7gjEiNBXB1eo8KsFiMlJyqo3TXcF9hCWiXridtIAgp_CpYFAwhOTuxBB8GXwyHbFgB9k5lbzX8BG4yETSa2MItom27s6Wbm01FFVvQIT6ljGOrrC93h9-6ZR2Uorzbd5w7qAE/s1600-h/zulu+hut2.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 234px; height: 146px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd_TMpCj7gjEiNBXB1eo8KsFiMlJyqo3TXcF9hCWiXridtIAgp_CpYFAwhOTuxBB8GXwyHbFgB9k5lbzX8BG4yETSa2MItom27s6Wbm01FFVvQIT6ljGOrrC93h9-6ZR2Uorzbd5w7qAE/s400/zulu+hut2.jpg" alt="" id="BLOGGER_PHOTO_ID_5378343818970664322" border="0" /></a><a style="color: rgb(153, 153, 153);" href="http://www.poemd.blogspot.com/">Dan J. Schmidt</a> tells a story on <a href="http://www.pulsemagazine.org/"><span style="color: rgb(153, 153, 153);">Pulse</span> </a>about why he<span style="color: rgb(102, 51, 255);"> </span><a style="color: rgb(102, 51, 255);" href="http://www.pulsemagazine.org/Archive_Index.cfm?content_id=71">chose to go into Family</a><a style="color: rgb(102, 51, 255);" href="http://www.pulsemagazine.org/Archive_Index.cfm?content_id=71"> Medicine</a> despite the allure of surgery and trauma<span style="text-decoration: underline;">.
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<br />Elizabeth Gudrais brings us<a style="color: rgb(102, 51, 255);" href="http://harvardmagazine.com/2009/09/atul-gawande-surgeon-health-policy-scholar-writer"> an article about Atul Gawande</a>, a "slightly bewildered" surgeon who also writes for the New Yorker.
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<br /><div style="text-align: left;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-YpAw8D1ZMJo9Efq-V1FkcBnywFn-FpBcauPDN1EYjf4nFuA-3ac91gAzN-sXduCM1aQAW4oVja5tJvpp_MiPOokZMRgoP43Gys3jQ8cIvnYg5bV8zxnpQK8W3Qr7kL30JBfX7BswXUQ/s1600-h/speeding.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 127px; height: 96px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-YpAw8D1ZMJo9Efq-V1FkcBnywFn-FpBcauPDN1EYjf4nFuA-3ac91gAzN-sXduCM1aQAW4oVja5tJvpp_MiPOokZMRgoP43Gys3jQ8cIvnYg5bV8zxnpQK8W3Qr7kL30JBfX7BswXUQ/s400/speeding.jpg" alt="" id="BLOGGER_PHOTO_ID_5378367933124986498" border="0" /></a></div><a style="color: rgb(153, 153, 153);" href="http://colondoctor.blogspot.com/">Ralph Silverman: The Colon Doctor</a> talks about <a style="color: rgb(102, 51, 255);" href="http://colondoctor.blogspot.com/2009/09/legal-pitfalls-in-surgery-what-not-to.html">legal pitfalls in surgery</a>.</div>
<br />A <a style="color: rgb(102, 51, 255);" href="http://jubelhunden.livejournal.com/193336.html">shocking story</a> of a Swedish surgeon who removed an ovary instead of the appendix and only received a warning.
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<br /></div><div style="text-align: left;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb6kehmKFehx3aH0z96RtNBGAz_HETiqmgtZR1tI2atZbQGiyJ8juvux6CPe9Fz32hMWcbRZfAsKMTvBEwXqK8apHSJuemTY5fYGOSM_A2KjxSET3yMyeheA5ApI_2zoRRtgpCh9RWYKQ/s1600-h/bushman+internet.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 116px; height: 116px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb6kehmKFehx3aH0z96RtNBGAz_HETiqmgtZR1tI2atZbQGiyJ8juvux6CPe9Fz32hMWcbRZfAsKMTvBEwXqK8apHSJuemTY5fYGOSM_A2KjxSET3yMyeheA5ApI_2zoRRtgpCh9RWYKQ/s400/bushman+internet.jpg" alt="" id="BLOGGER_PHOTO_ID_5378367921383784418" border="0" /></a>Howard Luks tells us in his<span style="color: rgb(153, 153, 153);"> </span><a style="color: rgb(153, 153, 153);" href="http://hjluks.posterous.com/">Orthopaedic Posterous</a> <a style="color: rgb(102, 51, 255);" href="http://hjluks.posterous.com/my-experience-with-social-media-email-and-hea">how social media has influenced his practice positively</a><span style="color: rgb(102, 51, 255);">.
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<br /></div><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilalWK6xjtxc3Zrr5sHiXxQDn4l9rr7FdTO8jIpV3YdxlqVhpuxNd8zR1ebeKoR7b9I_hiyjqGoYDeizi_4E2Pivh2ztGB3xoNUol8sHtweGCMKdzhLojqJKL4VsY6F8Kj01nNXR_0RiU/s1600-h/african+motorbike.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 250px; height: 170px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilalWK6xjtxc3Zrr5sHiXxQDn4l9rr7FdTO8jIpV3YdxlqVhpuxNd8zR1ebeKoR7b9I_hiyjqGoYDeizi_4E2Pivh2ztGB3xoNUol8sHtweGCMKdzhLojqJKL4VsY6F8Kj01nNXR_0RiU/s400/african+motorbike.jpg" alt="" id="BLOGGER_PHOTO_ID_5378367913717060450" border="0" /></a><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk1WX8btV-o1e29eXPzb7iMfRbwXPxULv6acLI2yYlDIbRG_quKRYvAFQ3fpK77i1GQbDZMnHBWIQvIDhfc0BGQs_lLy1WFwNoXywO5ShbQD1TmSD5mBBmULazCIp6zuxGHAso0SYKa_Q/s1600-h/african+gadgets.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 136px; height: 181px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk1WX8btV-o1e29eXPzb7iMfRbwXPxULv6acLI2yYlDIbRG_quKRYvAFQ3fpK77i1GQbDZMnHBWIQvIDhfc0BGQs_lLy1WFwNoXywO5ShbQD1TmSD5mBBmULazCIp6zuxGHAso0SYKa_Q/s400/african+gadgets.jpg" alt="" id="BLOGGER_PHOTO_ID_5378360201245175602" border="0" /></a>Adam Frucci from <a style="color: rgb(153, 153, 153);" href="http://www.gizmodo.com.au/">Gizmodo</a> tells us about a <a href="http://www.gizmodo.com.au/2009/09/brain-surgery-simulator-is-like-trauma-center-but-legit/"><span style="color: rgb(102, 51, 255);">Brain Surgery Simulator</span>.</a> Looks like a very useful tool for neurosurgeons to plan their surgery.
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<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4KHHqlY7Fi8UVsqZhwKj6tYWWS_xOtOKmqKcnadgnnkfwuDp5WZIPBiwVR6U7KddS6p5S_gHoOFimZxjJRZ0eE6UO0UBU1WiwKd2e6Mm_TCmrHt-wp-czKGUBp31qaxxnliu9oJWTw7k/s1600-h/Zimbabwe+Zimbabwean+Dollar++100+Billion+Dollar+Note.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4KHHqlY7Fi8UVsqZhwKj6tYWWS_xOtOKmqKcnadgnnkfwuDp5WZIPBiwVR6U7KddS6p5S_gHoOFimZxjJRZ0eE6UO0UBU1WiwKd2e6Mm_TCmrHt-wp-czKGUBp31qaxxnliu9oJWTw7k/s400/Zimbabwe+Zimbabwean+Dollar++100+Billion+Dollar+Note.jpg" alt="" id="BLOGGER_PHOTO_ID_5378357985902843618" border="0" /></a>Wat Tyler talks about <a style="color: rgb(102, 51, 255);" href="http://burningourmoney.blogspot.com/2009/09/emergency-surgery-on-nhs.html">the shortcomings of the NHS, reform and a possible solution</a> on <a style="color: rgb(153, 153, 153);" href="http://burningourmoney.blogspot.com/">Burning our money.</a>
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<br /><img src="file:///C:/Users/Delre/AppData/Local/Temp/moz-screenshot-1.jpg" alt="" /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEink3GXrSp1bE4gGMACC-PIEf8Lw6t2O5epY6NSHg3yVR9ytEPV2LwoyFNJWmaRT6iTsu8WknQzVEdBeNL5B7JSyfn0I4nf2yIQ-GvBYHThAug1uUt54A6qZli4fDz4E_GElX5r1bLmq7k/s1600-h/3003.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 220px; height: 151px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEink3GXrSp1bE4gGMACC-PIEf8Lw6t2O5epY6NSHg3yVR9ytEPV2LwoyFNJWmaRT6iTsu8WknQzVEdBeNL5B7JSyfn0I4nf2yIQ-GvBYHThAug1uUt54A6qZli4fDz4E_GElX5r1bLmq7k/s400/3003.jpg" alt="" id="BLOGGER_PHOTO_ID_5378376846066509906" border="0" /></a>The next edition of SurgeXperiences will be over at <a href="http://other-things-amanzi.blogspot.com/">Other Things Amanzi</a> on 20 September 09. Be sure to submit your posts via <a href="http://blogcarnival.com/bc/submit_1852.html">this form</a>.
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<br /><span style="font-size:130%;"><span style="color: rgb(255, 102, 0);">Thanx for coming!</span></span>
<br />amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com7tag:blogger.com,1999:blog-4893667773099408963.post-78247766065014668442009-08-30T06:29:00.000-07:002009-08-30T06:58:55.153-07:00SurgeXperiences 305<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQl6cUePpPkw2dpK2a0oxsbiaVQ3H677t8sXAgdfqk9aUViCezgFnrrD3XvrqmOE52jHAlUTFKhh2C-kSuovVxGT2zUAdCGgbFrvoqDJzhL2Ly_k7SfM6hHXEHRD4r9RSnnavpXFLUNzc/s1600-h/instruments.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 155px; height: 155px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQl6cUePpPkw2dpK2a0oxsbiaVQ3H677t8sXAgdfqk9aUViCezgFnrrD3XvrqmOE52jHAlUTFKhh2C-kSuovVxGT2zUAdCGgbFrvoqDJzhL2Ly_k7SfM6hHXEHRD4r9RSnnavpXFLUNzc/s400/instruments.jpg" alt="" id="BLOGGER_PHOTO_ID_5375752649016855154" border="0" /></a><br /><br /><br />Surgexperiences edition 305 will be hosted here on 6 September 2009!<br /><br />This surgical blog carnival is open to anyone and everyone who has a surgical blog or article to submit.<br /><br />Please submit your articles via <a href="http://blogcarnival.com/bc/submit_1852.html">this form</a> by midnight on Friday 4 September.<br /><br />Looking forward to reading your articles!amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com1tag:blogger.com,1999:blog-4893667773099408963.post-9829113127560633282009-08-05T09:36:00.000-07:002009-08-05T04:58:52.919-07:00Don't judge a book by its coverFew patients around these parts are clued up about their health care. They usually don't have any idea what medical conditions they have or what medication they are taking and why (patients on ARVs tend to be the exception, but even they can't usually tell you on their first visit what other medical conditions they have). Add to that that there is usually a language barrier, and taking a history can be difficult at best in South Afican hospitals. I have an interpreter at my disposal these days, but back in my student and intern days it took very long to figure out why a patient was presenting. I would often hit a snag at the second question "How old are you?"("What is your name?" would usually go off without a hitch). Back in medical school it took all of us a little while to figure out that when we asked a patient their age, they were giving us the year in which they were born instead. None of them actually knew how old that made them. They would say "64" meaning 1964, but we didn't know that at first and we'd say to each other " but he doesn't look that old". It was a waste of precious time in short cases in clinical exams when you'd have to waste 2 of your 15 minutes trying to figure out how old someone was when you could have been asking them important stuff (like what their dog ate ;)) <br /><br />I saw this patient a while back. He didn't speak English to me so I used an interpreter to take his history. He had a miriad of complaints, none of which I can remember now because none of them were very serious. When I examined him, I noticed he had a rash which looked suspiciously like a drug induced rash. I asked the interpreter to ask how long he'd had it and whether he'd been taking any medication before it started. He answered her in Swazi. I said out loud "This looks like a drug rash". He looked at me and said "It was a Stevens-Johnson syndrome that was caused by TB treatment. I was in hospital for about a week and then it got better."amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com2tag:blogger.com,1999:blog-4893667773099408963.post-7214587444645816892009-08-03T05:30:00.000-07:002009-08-03T08:31:45.184-07:00DisclosureDisclosure has always been a major controversial issue amongst HIV clinicians and the public at large. Unfortunately discrimination is still a fact of life around here. Many HIV positive people are the victims of unfair dismissal by their employees. Many are shunned by their communities and even their families. But when it comes to sexual partners, I don't think there should even be any question about disclosure. Yes, everybody should have safe sexual practices, but if you know you have HIV, I think you have a responsibility to your partner to tell them what they are getting themselves into before you get involved with them.<br /><br />I saw this patient: an older man who had quite advanced HIV disease. He was in a profession that implied that he was well educated. It was about his third visit and he was due to start <span class="blsp-spelling-error" id="SPELLING_ERROR_0">ARVs</span>. His wife and daughter were with him. He complained of urinary symptoms, so I asked my assistant to take him to have his urine tested. As soon as they had left, his wife turned to me and asked "doctor, has he been tested for HIV?" I was a bit puzzled for a moment. I tried to gauge what her understanding was of why her husband was seeking medical attention and that from an HIV clinic, but she did not understand what I was saying. She spoke a broken English whereas her husband was fluent in English. So fluent in fact that I did not use a translator to speak to him. The situation became clear to me: he had not disclosed his HIV status to his wife and because she was clearly not nearly as educated as he was and not able to speak English well, she had not been able to follow what was going on at his medical visits. He was not being forthcoming with her.<br /><br />Her husband and my assistant then returned, I pulled my assistant aside and said to her "this <span class="blsp-spelling-error" id="SPELLING_ERROR_1">patient's</span> wife just asked me if we have tested him for HIV. I think he has been keeping her in the dark about his diagnosis. Can you please speak to them and figure out what's going on." My assistant asked the wife to leave the room and spoke to the husband in his first language. In the meanwhile, I finished my clinical notes and filled in his prescription. After a while she called his wife back in and spoke to her for quite some time. She then led them away and told me she would fill me in on what had happened when she got back.<br /><br />This she did. The patient had been sick for quite some time. He had been married before and this was his second wife and he had in fact been sick when he had met her. I wondered who gets involved with a man who is so sick. But I digress. The wife was very young - she had just turned 21 - whereas her husband was in his fifties. He had not disclosed his HIV status to her, as I had suspected. But worse than that, he had known his HIV status when he first met her and did not tell her. My assistant had explained everything to her after speaking to her husband and had taken her HIV counselling and testing. She was positive. This woman was clearly not very intelligent and was very poorly informed about HIV, but her husband was clued up and had not only known he was HIV positive when he met her, but in all likelihood had transmitted it to her. My suspicion was reinforced by the fact that she was clinically very healthy, but not only that, she had a very healthy toddler with her. This implied that she had early stage HIV and probably did not have it when she was pregnant. Her husband, however, had very late stage HIV. I asked if the patient was the father of the child, who looked to be about 1 and a half years old, and my assistant said he was not. The woman had had the child before she met him. I breathed a sigh of relief. The child was most likely not HIV positive. I mentioned that the child should be tested anyway and my assistant said that the woman had decided to have the child tested at their next visit. The whole thing upset me so much, but at least the child would probably be <span class="blsp-spelling-error" id="SPELLING_ERROR_2">ok</span> I thought. But then it occurred to me that I had seen the woman breastfeeding the child - one of the ways HIV is transmitted from a mother to a child.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com4tag:blogger.com,1999:blog-4893667773099408963.post-89042018205557536262009-06-22T06:40:00.000-07:002009-06-24T08:21:04.660-07:00Master and servant<span style="font-style: italic;">"Many of my past relationships didn't work out because the other person didn't realise they belonged to me" </span>- Jack <span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">MacFarland</span></span>, Will & Grace.<br /><br />There is a syndrome which I believe to be uniquely South African. It is called <a href="http://www.plusnews.org/Report.aspx?ReportId=79265"><span style="font-style: italic;">"Madame syndrome"</span></a>. <a href="http://other-things-amanzi.blogspot.com/"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">Bongi</span> </a>coined the phrase. It involves middle class (usually white) women - the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">madames</span>, for this is how they are <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">addressed</span> - and their household help: the domestic workers. The <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">Madames</span> tend to take ownership over their employees - for their own good of course - and therefore usually accompany them to the doctor/clinic/hospital because they feel they are incapable of doing it by themselves. Incapable of telling the doctor what the problem is, understanding what the doctor diagnoses them with and totally incapable of understanding what medication they must take and how and why. One madame actually told a friend of mine, when told that her gardener was not a child but a person in his own right, that he had the mind of a child. Seriously.<br /><br />All of us have seen the Madame Syndrome and often, but it still irritates the crap out of me.<br /><br />The most satisfying encounter I've had with a madame was when one brought her <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">gardener</span> to the casualty unit of a hospital where he was accepted, even though he did not fall into the catchment area. She came to complain to me about the "<span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">blond</span> nurse" who had initially not accepted her <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">gardener</span> and who had given her "a hard time" before accepting him as a patient. That "<span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">blond</span> nurse" was in fact, not a nurse, but a doctor, and not just a doctor, but an emergency medicine specialist and happened to be the head of the emergency unit. When I told her this, she demanded to speak to the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">superintendent</span> of the hospital then. As the superintendent was away on leave, the "<span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">blond</span> nurse" also happened to be the acting superintendent at the time. The madame was furious and vowed to take further action. I thought she was ungrateful and pathetic, as our unit had accepted her gardener as a patient, against our policy and had given him pretty damn good treatment! I couldn't help but laugh inwardly at her frustration.<br /><br />Recently I was involved in two distinctly different cases of Madame Syndrome.<br /><br />The one involved a friend of a friend. This friend called me up one day to say that her friend had a problem. She had convinced her domestic worker to have an HIV test as the domestic worker's husband had recently <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">unexpectedly</span> succumbed to an unknown illness. The problem was that the HIV test had turned out to be positive and she now did not know how to break it to her or what to do about it. That's right, she had taken her to have an HIV test, she had had no counselling or preparation, and then she was not even given her own results! The pathologist had given the results to the madame! I was disgusted, although I didn't make this evident. I told her that the best thing to do would be for her friend to bring in her domestic worker and we would do proper counselling, testing and further management. Afterwards I was fuming. I have always had a low tolerance for madames. I decided that I would speak to her if she came in with her domestic worker on the appointed day, which she inevitably would. Unfortunately, our paths did not cross.<br /><br />The other case was a proper referral. I saw the madame in the waiting room with whom I assumed was her gardener (he turned out to be one of her farm hands). I was annoyed before the fact. As it turned out, when it came to be his turn, I happened to be the next available doctor. He needed to have his vital signs taken, so he was taken to the nurse's room first. I got ready for a confrontation when he was called and his madame started following him to the room. There wasn't enough space in the room so she waited at the door. I went into the room, closed the door and asked the nurse to ask him who the woman accompanying him was and if he wanted her to come in with him for the consultation. He said that she was his madame. He said that he did not want her to come in. He was the patient and he had decided so I prepared to enforce it.<br /><br />When his vitals had been taken, I asked him to follow me to my room. His madame followed. When we got to the door of my room I stopped and asked her "Are you his employer?" and she said "Yes". "I'm going to have to ask you to wait outside" I said. <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">Unexpectedly</span>, she answered "Of course". I felt a bit confused actually. She went on to say "I'm a registered nurse and I respect his confidentiality, I just wanted to tell you what I know." She told me what doctors he had seen previously, what they had diagnosed, what they had prescribed and the progress he had made. I felt a bit sheepish. "Thank you" I said. She waited outside during the consultation. I asked the patient if he wanted me to tell his madame what I'd found and what I would do. He had absolutely no problem with it, so I called her in and brought her up to speed. She was very co-operative and very grateful and I had a chance to see them interact with each other. Their relationship was not the typical master-subordinate one I was so used to seeing. I was pleasantly surprised.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com0tag:blogger.com,1999:blog-4893667773099408963.post-46153986119029311562009-05-31T04:44:00.000-07:002009-05-31T06:48:49.289-07:00In mourning<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivpO1ur4Z3SQO3Az58DH5nkqX4ga9cf8DnwH20HfXOdtTfDap5ks1JJVaiQD6g-5oUHtG6sNmmR0KSrOnvryskWt4OvYYMDOu2lLdFQ6i7AwgGE8kH9PT_r93KIUYAIckHwJXLZT5cK_g/s1600-h/black+roses+2.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 168px; height: 168px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivpO1ur4Z3SQO3Az58DH5nkqX4ga9cf8DnwH20HfXOdtTfDap5ks1JJVaiQD6g-5oUHtG6sNmmR0KSrOnvryskWt4OvYYMDOu2lLdFQ6i7AwgGE8kH9PT_r93KIUYAIckHwJXLZT5cK_g/s400/black+roses+2.jpg" alt="" id="BLOGGER_PHOTO_ID_5341953185860416050" border="0" /></a><br />The ones left behind. In my line of work and especially in the setting in which I work, I see <span class="blsp-spelling-error" id="SPELLING_ERROR_0">alot</span> of widows. There is still a very strong belief in the local community where I work that a widow should be completely dressed in black for at least 6 months and even for up to a year. I've already been told by my significant other that if he were to die, I have to wear black from head to toe for a year!<br /><div style="text-align: left;"><br />But seriously, I always feel a deep sense of loss when I see one of these women in the waiting room and especially when one of them consults me. In true doctor stereotype, I never really know what to say to them. I mean, what can you really say to someone who has lost their life partner? Yes, some people take it harder than others, but I just imagine how devastated I would be if it were to happen to me. I usually just give my condolences, which they acknowledge, and then feel very inadequate. I always send them for grief counselling - I have such respect for those counsellors for knowing what to say and do.<br /><br />As doctors, I think we tend to try and stay clinical because the work we do and the things we see would destroy us in no time if we reacted to it as people normally do under normal circumstances. But we do not work under normal circumstances. The circumstances are extraordinary, unnatural. So we keep a certain distance. We get philosophical. We switch off when it gets too emotional or when we can feel it permeating too deeply. But neither can we allow ourselves not to be affected or we would be in danger of losing our humanity. So I feel their loss. Then I move on.<br /><br />I think it is probably a sexist society that dictates that a widow must outwardly show her grief by wearing black whereas a widower is not under any obligation to show any outer sign of mourning, but then again, most cultural norms and beliefs are passed from generation to generation by the women of that culture. Still, I think it is a very beautiful thing for a woman to show that she is mourning her husband's loss. However, I don't think that she should be forced to do it. In any case, whenever I see one of these women in black, I find it very poignant.<br /><br /><br /><br /><br /></div>amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com10tag:blogger.com,1999:blog-4893667773099408963.post-39983235153575876072009-05-24T12:03:00.000-07:002009-05-24T12:03:00.379-07:00Misinformation<div style="text-align: right;">I read this article in a parenting newsletter recently and was actually impressed with its useful advice. However, there were two things that bothered me about it: firstly it states that probiotics strengthen your immune system, which isn't actually true, although it does boost the immunity of your intestinal mucosa, so it is somewhat true. But then it also had a blatantly false statement saying that anti-oxidants scavenge viruses and bacteria.<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWxrNBjor-r26Tqr4BOKNzxgm7QovrGt4ROUazm6SXpAmf8he9Pbg_mvxyD9C1INiyIBF7a_6kxy2BqiskzIBPxqSiJ2u3zh5I7B_i4aITkEQlCNM8g_d3ulXrPPmSYxFR7QxW2nPVN7w/s1600-h/scan0001.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 337px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWxrNBjor-r26Tqr4BOKNzxgm7QovrGt4ROUazm6SXpAmf8he9Pbg_mvxyD9C1INiyIBF7a_6kxy2BqiskzIBPxqSiJ2u3zh5I7B_i4aITkEQlCNM8g_d3ulXrPPmSYxFR7QxW2nPVN7w/s400/scan0001.jpg" alt="" id="BLOGGER_PHOTO_ID_5338695792313632098" border="0" /></a></div><div style="text-align: right;"><div style="text-align: left;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuW7DkqrB_w6WlzreFcnAdfo76b2yO_9MZQGdV6CSqjGn0FNejO5Lkx9eXU1Mj_FHVamUIWZPIrTZyK6ZNtJRa7VofcXhyphenhypheny-dVzkCoqOl48C_Sc9EiESAZFDBgYOgaKNook_86knA0bxY/s1600-h/scan0003.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 289px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuW7DkqrB_w6WlzreFcnAdfo76b2yO_9MZQGdV6CSqjGn0FNejO5Lkx9eXU1Mj_FHVamUIWZPIrTZyK6ZNtJRa7VofcXhyphenhypheny-dVzkCoqOl48C_Sc9EiESAZFDBgYOgaKNook_86knA0bxY/s400/scan0003.jpg" alt="" id="BLOGGER_PHOTO_ID_5338695968852048882" border="0" /></a><br /></div><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><div style="text-align: left;">I decided to write to the editor. I didn't mention the probiotics statement because I thought there was an element of truth in it, but I pointed out that the antioxidants statement was completely false and that although antioxidants do infact help your body fight viruses and bacteria by scavenging free radicals and thereby strengthening the immune system, they do not directy fight viruses and bacteria. I thought this was important because perhaps the next time Jane public's kid has a bacterial infection she might think it's ok to only give the kid some anti-oxidants. Which may not be the brightest thing to do, but it illustrates how misinformation can be dangerous, especially in today's media hungry, self diagnostic world. </div></div><p>The editor forwarded my letter to the dietician who sent me a direct response:<br /></p><span style="color: rgb(31, 73, 125);font-family:'Lucida Grande';font-size:11;" ><span style=";font-family:Verdana;font-size:85%;" >Thank you for your comments. Indeed, this is a good </span></span><span style="color: rgb(31, 73, 125);font-family:'Lucida Grande';font-size:11;" ><span style=";font-family:Verdana;font-size:85%;" >example of what can so easily happen and the dilemma with which we are often faced w</span></span><span style="color: rgb(31, 73, 125);font-family:'Lucida Grande';font-size:11;" ><span style=";font-family:Verdana;font-size:85%;" >hen having to try to translate complex and often detailed explanations into simple language whilst having a limited number of characters at our disposal. For example, consumer research has shown that even a concept such as 'FREE RADICAL ' is poorly understood - let alone oxidate damage, reactive oxygen species etc.<br /><br />I am certainly very aware that anti-oxidants in fact are involved in the complex processes relating to free radical damage associated with oxidative processes, that some do not necessarily posess anti-oxidant status (e.g. zinc) but are important in inherent defence mechanisms and that the link is not necessarily directly between the anti-oxidant and the bacteria/virus. However, in the spirit of the article and trying to make the point that food remains vital to enhance health - rather than supplements, I have tried to simplify the complexities associated with anti-oxidant functioning, colds and flue and the potential and role nutrients have and play in preventing disease. In addition, our editorial team had to cut text again and in the process of this, another bit of vital info got lost.<br /><br />You are therefore 100 % correct in your assessment that this statement is not 100 % correct - thank you for bringing this to our attention</span></span>.<br /><span style="color: rgb(31, 73, 125);font-family:'Lucida Grande';font-size:11;" ><span style=";font-family:Verdana;font-size:85%;" ><br /></span></span>I feel she was trying to justify telling an untruth for the greater good - although in this case it was actually a lie - and I'm not sure if that is justifiable. I think that as medical professionals we are obligated to hold ourselves to higher standards.<br /><span style="color: rgb(31, 73, 125);font-family:'Lucida Grande';font-size:11;" ><span style=";font-family:Verdana;font-size:85%;" ><br /></span></span>amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com2tag:blogger.com,1999:blog-4893667773099408963.post-21287315609671354302009-05-22T07:41:00.001-07:002009-05-22T09:17:16.566-07:00Foot-in-mouth disease<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTIs4QQnhjHnVOesWAzM2lNrZ_DjTma9hPnRIsT3hTF-0e28SWQxx4jyusuQBA3ce1DNahKqQF6Rh8cKgUi_yKr9oyiDsHU7HfO5p5CrYMGp6JIuYdwutak72A55WHEYObBWxF3ufnCuU/s1600-h/foot+in+mouth.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 255px; height: 188px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTIs4QQnhjHnVOesWAzM2lNrZ_DjTma9hPnRIsT3hTF-0e28SWQxx4jyusuQBA3ce1DNahKqQF6Rh8cKgUi_yKr9oyiDsHU7HfO5p5CrYMGp6JIuYdwutak72A55WHEYObBWxF3ufnCuU/s400/foot+in+mouth.jpg" alt="" id="BLOGGER_PHOTO_ID_5338682122201329970" border="0" /></a>I was assisting in threatre today and we were doing laparascopic work. We were using a new system from a guy whose equipment we've used before - and this guy is really panicky on a good day. So today he actually had to be somewhere else, so he had someone else come to theatre (I think she's his rep or something) to see that there weren't any glitches. So at a stage, the surgeon tells this rep to phone the guy and tell him the screen is not working, the surgeon is screaming and that all hell has broken loose, basically.</div><p>She says she's a bit nervous do that because she's still rather new. So the anesthetist (who is just as bad as the surgeon, if not worse) volunteers to do it. He dials and the surgeon says "tell me when you're speaking to him and I'll start shouting". He chuckles menacingly. The guy answers and he puts the call on speaker phone.</p><p>He tells him that nothing is working and that nobody knows how to fix it. The surgeon timeously shouts "I can't work under these conditions!". The anesthetist goes on to say that his rep has been reduced to tears.<br /></p><p>"I knew I should have come myself" he says, "I knew she couldn't handle it!"<br /></p><p>The theatre explodes with laughter and he realises he's been had. He says something about the surgeon always trying to unnerve him. We all laugh.</p><p>Everyone except his rep that is ;)</p>amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com2tag:blogger.com,1999:blog-4893667773099408963.post-50465950063483178802009-05-16T00:58:00.001-07:002009-05-16T03:32:18.204-07:00...pants on fire<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfguzGJRESBxTEiiWU3IhKwOfGvy0ajQRsKzejgi1ZmsVnHGBbb3DGlV_kKip1v0Fjg6flDAZNDhK699bn3c-41x0fo5TNbNzWXpZQHKv3kWR1zWb9oDD69HospASeyPiCk7lyOBV_Ou4/s1600-h/pants+on+fire.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 112px; height: 162px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfguzGJRESBxTEiiWU3IhKwOfGvy0ajQRsKzejgi1ZmsVnHGBbb3DGlV_kKip1v0Fjg6flDAZNDhK699bn3c-41x0fo5TNbNzWXpZQHKv3kWR1zWb9oDD69HospASeyPiCk7lyOBV_Ou4/s400/pants+on+fire.jpg" alt="" id="BLOGGER_PHOTO_ID_5336358060522972898" border="0" /></a><br /><br />I've often wondered why patients bother to<a href="http://other-things-amanzi.blogspot.com/2007/11/dont-believe-word.html"> lie</a> to their doctors. We have seen just about everything in the book as well as most things not in the book.<br /><br />There's not much that phases me anymore and when someone has done something really stupid or embarrassing, I tend not to judge them, but when they lie (and trust me, a doctor tends to know when a patient is blowing smoke) that just down right annoys me...<p>If you get shot or stabbed in the middle of the night and come into casualties in a drunken stupor, we are not going to buy your story that you were selling bibles door to door and some heathen attacked you unprovoked and unexpectedly because you have nothing but goodness in your heart.</p><p>If come in with a foreign body stuck in your rectum, we are not going to believe that you were naked because you were on your way to the shower and en route accidentally slipped and fell onto it!</p><p>If you have half a steak stuck in your oesophagus, we are not going to believe that you only took a small bite and that it must have somehow expanded because of all the water you drank to try and wash it down.<br /></p><p>Medicine is evidence based, so if the evidence is there, we'll believe what the evidence shows us. </p><p>I had this patient who complained of severe earache. I had a look and saw mostly wax, but peaking out from behind the wax I saw something which didn't look entirely normal. I actually thought it kind of looked like the leg of on insect - those things can get anywhere. I told myself it may just be a hair coated in wax, but I was not convinced, so I had no choice but to syringe the ear. Now, I absolutely hate syringing ears. When I was a 4th year medical student, we went on an "ENT camp" which basically entailed us syringing the ears of underprivileged patients for three days straight. It was horrible. I saw (and smelt) things there that I never want to see (or smell) again. But obviously I had to do it.</p><p>So I syringe and a whole lot of wax comes out. Then I look in her ear again and see what looks like tissue paper or cotton wool. So I ask if she had put an ear bud or something into her ear and she says no, she didn't put anything in her ear. Yeah right, I think. I syringe again and more wax comes out. Then, I syringe and out comes a blob of cotton wool coated in wax. I pick it up and show it to her.</p><p>She says she doesn't know how that got in there.<br /></p><p><br /></p><p><br /></p>amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com11tag:blogger.com,1999:blog-4893667773099408963.post-26307454458882722062009-05-12T09:48:00.000-07:002009-05-12T09:58:55.527-07:00Road worksMy commute to and from work has been quite difficult lately: there are road works on the <span style="font-style: italic;">one and only </span>road between the town where I live and the town where I work. It's quite annoying to have to sit in such slow moving traffic every morning and every afternoon considering we moved here to get away from the big city and its evils such as traffic.<br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZFeO4sIZ_BaZPi8fhI3CUwNEtmNsIgBc3VizQhCW4LBvEBwzvQwm0hE_bFF6KMxW-x-tc2txFrmD8-eHHwyIbZRfXmU1Uf1mTh6rvN8FnZoCvh4m0CRAJoTxZPjlmClO2pLq-iKCkaAg/s1600-h/phone+photos+013.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 190px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZFeO4sIZ_BaZPi8fhI3CUwNEtmNsIgBc3VizQhCW4LBvEBwzvQwm0hE_bFF6KMxW-x-tc2txFrmD8-eHHwyIbZRfXmU1Uf1mTh6rvN8FnZoCvh4m0CRAJoTxZPjlmClO2pLq-iKCkaAg/s320/phone+photos+013.JPG" alt="" id="BLOGGER_PHOTO_ID_5334982274389670562" border="0" /></a><br />I must say though that if the company doing the construction cannot even label its construction vehicles properly, I have very little faith in them building our roads and bridges!amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com3tag:blogger.com,1999:blog-4893667773099408963.post-79732353474885134112009-04-03T09:58:00.000-07:002009-04-03T10:59:24.693-07:00That's Doctor Evil, I didn't go to six years of evil medical school to be called miss, thank-you very much...I've had my share of difficult patients but one in particular stands out...<br /><br />This patient was an older man who was referred from the occupational health clinic at his place of employment. He was in the public transport industry. He was HIV positive with a CD4 count of 186 and had recently completed a full 6 month course of TB treatment. The referring sister had sent him for ARV treatment.<br /><br />This was his second visit and one of my colleagues had seen him previously, repeated the CD4 and taken some other baseline blood tests. He had also prescribed some vitamins and sent him for an adherence class to prepare him for starting ARV's. I now had his blood results before me. His CD4 count had gone up to 258 - not really surprising since the CD4 count fluctuates anyway, but more because it tends to go down when a patient has an opportunistic infection such as TB an goes up again once it's been treated. I conveyed this information to him. He understood English but didn't speak it very well so he spoke to my assistant in Swazi and she translated for me. He said that he did not want to start ARV's as he didn't need them now since his CD4 had gone up. That's reasonable I thought. The cutoff for ARV's in our country is 200, even though the WHO recommends 350 in countries such as ours where TB is rife. We tend to start at higher CD4's than the state clinic's so he could still have started ARV's then if he wanted to but it was also ok to wait a while.<br /><br />But I had also noticed that his blood pressure was very high. I checked my colleague's notes and saw that it had been high at the previous visit as well. It was so high that lifestyle changes alone would not good be enough. I explained to him what it meant, about end organ damage and that we needed to start him on anti-hypertensives.<br /><br />His response was simply that his blood pressure was not high.<br /><br />I explained that it was in fact high. Again he told me that it was not. Just like that.<br /><br />I was a bit stunned and didn't quite know how to respond to this. I've seen patients who were in denial about TB or HIV before but never one who was in denial about Hypertension! I was also quite insulted that this uneducated man simply disregarded my medical education and clinical skills and simply told me that I was wrong.<br /><br />I took a deep breath. I had visions of him transporting a load of people and having a stroke or heart attack behind the wheel, crashing and leaving a bunch of dead people scattered all over the tarmac.<br /><br />I remained calm. I told him that I was not doing guess work, that this was a physical parameter and that I had measured it and it was, despite his expert input, high and needed treatment. I tried to convey to him that he was responsible for the people he transported and that with a blood pressure that high, a stroke was a high likelihood.<br /><br />At this point he got aggressive. He told the interpreter that there was in fact<span style="font-style: italic;"></span> <span style="font-style: italic;">nothing</span> wrong with him, he did not have high blood pressure, he did not even have HIV, he <span style="font-style: italic;">did</span> have TB but that had been treated, so there was actually nothing wrong with him now. He said that we were wasting his time and that the last time he'd been there, he'd flushed the tablets we'd given him down the toilet. I must admit I found that a bit amusing. Why did he even bother to take the tablets then? I pictured him standing over the toilet cursing and angrily flushing the tablets away, mumbling about how he was in perfect health and we were all deluded. He said that the only reason he was attending was because he had been referred to us by his occupational health nurse and because his employer was paying for it and had money to throw away.<br /><br />I developed an acute case of compassion fatigue.<br /><br />I sent him on his not so merry way, didn't bother to give him a follow up date and sent a letter to his occupational health nurse by email asking for him to be boarded him until his blood pressure was under control. I then called her to make sure she had received my letter and discuss the case with her. She shed some light on the matter saying that very high blood pressure was considered an occupational hazard and that he knew this, which was probably why he had behaved the way he had.<br /><br />I had little sympathy for him. It was a problem that was easily solved, but he was not interested. If he didn't want treatment, that was his problem, but I was not about to let him put innocent people at risk.<br /><br /><br /><span style="font-style: italic;"><span style="font-style: italic;"><span style="font-style: italic;"></span></span></span>amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com3tag:blogger.com,1999:blog-4893667773099408963.post-45844116955517246412009-04-01T08:10:00.000-07:002009-04-01T08:22:46.372-07:00ShockedI heard on the news today that a doctor at a Johannesburg hospital allegedly raped a patient <a href="http://www.ewn.co.za/articleprog.aspx?id=10444"><span style="font-style: italic;">at the hospital's rape centre</span>!</a> So this woman was raped, and then the doctor who was supposed to help her and care for her, violated her. It's too shocking for me to accept that this sort of thing can happen. Even in South Africa.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com2tag:blogger.com,1999:blog-4893667773099408963.post-85446176019199533712009-03-20T23:21:00.000-07:002009-03-21T00:53:24.849-07:00SexismI recently attended some lectures where the speaker told us about an exam question she'd set about adherence to HIV drugs. Some guy had answered: 1. Rural people cannot be trusted to be adherent 2. Especially women.<br /><br />Needless to say, he failed.<br /><br />It got me thinking about sexism in medicine. It's is one of the disciplines where sexism is not really an issue anymore. Females doctors are equally respected and are paid the same for doing the same job. But sexism definately still rears its ugly head on occasion. Especially in surgery. I recently experienced it myself. At least I think it was. Maybe I'm wrong.<br /><br />There's this surgeon who I assisted every Friday. I then went on maternity leave but there was an understanding that when I came back, I would once again be his regular Friday assistant. However, when my maternity leave was over, he told me that he had gotten a new regular assistant, an older man, and that he couldn't just let this guy down. He suggested I could assist him every alternate Friday. I pointed out that he had essentially given my job away. I told him that the clinic where I work the rest of the time had also gotten a replacement while I was away, but had told that locum that when I came back, they would have to leave. Let me just mention here that I was on unpaid leave, so my employers didn't even lose any money while I was away. Anyway, the surgeon eventually agreed that I should be his regular Friday assistant again.<br /><br />This past Friday, I assisted, but the first case was a Nissen so the new guy was also there. He took of aside and said I could decide what I wanted to do. Of I course I said that I would prefer to do the camera work if he didn't mind. He said it's fine, but when we told the surgeon our decision, he said he wanted the new guy to do the camera work since his eye was now in (and I had just come back) and that I could do it next time. Fair enough, I thought.<br /><br />Okay, here comes the incident in question. I noticed that the surgeon allowed the new guy to do all the prep work for the op. He had never allowed me to do this. He was always a control freak when I assisted him. He always did all the prep work because he said he was the only one who could do it properly. I thought he was just being a typical surgeon. Yet, now, he was letting the new guy do everything. After the op, I spoke to him in private and asked why he never allowed me to do the prep work but allowed the new guy to do it. He said that he trusted new guy because he had corrected him on all his flaws and had perfected his technique. He tried to make light of it and told me I might find it funny to know that the first time the new guy did it, he didn't dry the lenses properly and it was a complete mess up. He laughed. I didn't find it funny. What I got out of this little exchange was that the first time new guy took the equipment and started to prepare it, the surgeon did not stop him as he had always done me. And even though he messed up, the surgeon allowed him to do it again a few times, because that's what it takes to "perfect your technique" in my mind. I didn't say anything more on the topic.<br /><br />Maybe I just misinterpreted what happened, but I doubt it.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com8tag:blogger.com,1999:blog-4893667773099408963.post-85079579273479468722009-03-20T23:10:00.000-07:002009-03-20T23:19:50.714-07:00Leave of absenceI haven't posted for a long time. Having two small children and then going back to work as well has kept me busier than I could ever have imagined, so I haven't had much time to do anything else, let alone blog. This has also been aggravated by the fact that my phone's been giving me problems so I couldn't blog with it, and I can't usually use the computer at home because a certain surgeon tends to hog it :) Hopefully I can get back into things now.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com2tag:blogger.com,1999:blog-4893667773099408963.post-19585796984632110582008-11-05T08:53:00.001-08:002008-11-05T11:12:29.342-08:00Red tape<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxmDfRFEnqnFtKK2tqcozZIPdFzykkFzKAa3tDiOiK8GTC_BEYUDUzzET0dCsF_ush-6SuVPQSJuJs27NYzlabdQl5JjI_pHrbHq2XapsB6RV06xCpldXEyt4tiYrnJLiR5zSsrtBDoMk/s1600-h/9GQS8ICAC48PBOCAXR0ICFCAK1482VCALI7QYUCAA3JIMKCADLI03ACADAZQT0CA9X9838CAQACVC1CAJC6XCDCA4AOPM5CAWNSA9BCA62LX08CA5QJH1ICA82KSRXCALBZ0J3CA30XH3GCAG9UVK8CAH5BEH6.jpg"><img id="BLOGGER_PHOTO_ID_5265247756760120418" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 117px; CURSOR: hand; HEIGHT: 78px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxmDfRFEnqnFtKK2tqcozZIPdFzykkFzKAa3tDiOiK8GTC_BEYUDUzzET0dCsF_ush-6SuVPQSJuJs27NYzlabdQl5JjI_pHrbHq2XapsB6RV06xCpldXEyt4tiYrnJLiR5zSsrtBDoMk/s320/9GQS8ICAC48PBOCAXR0ICFCAK1482VCALI7QYUCAA3JIMKCADLI03ACADAZQT0CA9X9838CAQACVC1CAJC6XCDCA4AOPM5CAWNSA9BCA62LX08CA5QJH1ICA82KSRXCALBZ0J3CA30XH3GCAG9UVK8CAH5BEH6.jpg" border="0" /></a><br /><br /><br />I find dealing with medical aid's extremely frustrating.<br /><br />Before I could be admitted for confinement I had to obtain a pre-authorization number from my medical aid scheme. The first time I called (which was about a month before my due date) I was told to call back in two weeks because the authorization was only valid for two weeks. I was also told that because it was for confinement, I could call at any time if I went into labour because obviously I could theoretically go into labour at any time and they would then immediately give me authorization. When I called back two weeks later I was told to rather call back on the day I went into labour because that would ensure the number wouldn't expire. Fair enough I thought.<br /><br />So on the morning that I started having contractions I called the medical aid for my authorization number. The call centre lady asked if my due date was still the same. "Yes" I answered, "but I'm having contractions now so that's why I'm calling for the number now". "Have you seen your doctor yet?" she asked. "No" I replied. There was a short silence, then she gave me the number. At the time I had so many other things on my mind that I didn't really have time to get annoyed.<br /><br />So I went to the labour ward that evening (21 October) <a href="http://amanzi-mtoti.blogspot.com/2008/11/nvd.html">as I've mentioned </a>and gave birth the next morning.<br /><br />This morning I received an account from the anaesthetist and a note asking me to submit the account to my medical aid scheme. I thought this was strange as accounts are usually submitted by a doctor's secretary so I phoned the medical aid to find out if they had in fact received the account. I was told that the claim had been rejected as their records show I was admitted on the 22nd and how could the doctor operate on me on the 21st if I wasn't even there? I was completely taken aback by the pedantry. Obviously there had been a mix up with the dates somewhere, but they were using this as an excuse not to pay out. I felt my spirits sink because I knew this meant I was in for a fight and I hate fighting.<br /><br />"I was admitted to the labour ward on the evening of the 21st" I said "and delivered the baby on the morning of the 22nd. And he didn't operate me, he gave me an epidural". "What time were you admitted to labour ward?" she asked. "In the evening around 5" I replied. I didn't see the relevence of the time, but anyway. "Well that's not what our records show" she said, "we'll need a motivation from the doctor". Damn, I thought. I know how much doctor's hate writing motivations. I could tell I wasn't going to get anywhere with this woman so I said goodbye and decided to call the hospital.<br /><br />Dealing with the hospital was pain free. I stated my problem and was immediately put through to the right person who told me that their records showed I was admitted on the 21st but that the medical aid had probably not received their account yet. She gave me her name and number and said I was welcome to ask the medical aid to phone her directly.<br /><br />I then decided to phone the anaesthetist's rooms and speak to his accounts lady to cover my bases. This was a mistake. When I told her what was going on she started moaning like a banshee. As I was listening to her tirade, I considered cutting her off and being short with her. After all, it wasn't my fault, why did I have to listen to her whining like I was her boyfriend? You don't shoot the messenger! But I decided to just let her go on because I was too tired to fight - I regretted this afterwards though. When she came up for breath after about 2 minutes of ranting, I told her I'd try to sort it out and get back to her. She then started ranting about the medical aid again before she finally said goodbye.<br /><br />I phoned the aid scheme again and told them that the hospital's claim did show I was admitted on the 21st. I was told that the authorization was for the 22nd. You have got to be kidding me, I thought. After all the run around I got from them about the authorization? This just pissed off. I was put through to another department.<br /><br />Once again I stated my case to the next person I spoke to. She put me on hold to check something and when she came back she told me that the project manager wasn't in so she took my number and told me... she'd call me back.<a href="http://amanzi-mtoti.blogspot.com/2008/11/nvd.html"></a>amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com11tag:blogger.com,1999:blog-4893667773099408963.post-34001194971110893492008-11-01T10:07:00.001-07:002008-11-01T15:59:26.138-07:00NVDSo I narrowly escaped having my baby cut out by a gynae.<br /><br />Due to unforseen circumstances, I ended up having my baby in Cape Town. This meant I had to find a new gynaecologist/obstetrician. My cousin suggested her gynae and I went with him.<br /><br />I started having contractions last Tuesday morning. As I've mentioned before, my first labour went very quickly, so I was anxious about waiting too long before going to the hospital. When my contractions started getting reasonably strong I decided that maybe it was time to go in. My partner suggested I rather call the gynae first. So I did and he suggested I go to his rooms and he'll check me out. When I got there, I was having fairly strong contractions. However, my cervix was still closed, but because my first labour had progressed so quickly and I was already having strong contractions, the gynae wanted me to go in to hospital. Both my partner and I were uncertain about this but we decided to go through. <br /><br />We went home first (my parents' home) to pick up our son and my mother to go along to the hospital. When we got to the labour ward, the nurses remarked on how the gynae had been phoning constantly to see where I was. Not a good sign.<br /><br />The midwife set me up in the labour ward and gave me an enema as per the doctor's instructions. Unpleasant. Anyway, she then told me she would call the anaesthetist to get me an epidural. I said I felt it could wait (I wanted to know how far I had progressed first because I didn't want to have the epidural too early) but she told me the gynae had said that the anaesthetist was very busy and that if I didn't get it then I might end up not getting it at all. My contractions were starting to get quite painful and I didn't want to end up not getting an epidural. Also, I knew they could top it up if started to wear off, so I agreed to go ahead with it. The anaesthetist who was first on call was indeed too busy so the second on call came in. He also apparently had alot lined up that night so in the end I was happy I'd gone for it then.<br /><br />The epidural was much more painful than my first one had been and I reacted quite badly to it. At a stage the anaesthetist even dropped my bed and drew up some adrenaline. I recovered with only fluid resus though. I felt terrible though and at a stage I even wondered what was worse: the pain or the effects of the epidural? (The epidural started to wear off later though and I came to the conclusion that the pain is definately worse!)<br /><br />Then my gynae came to see me. He remarked to the anaesthetist that he was exhausted. I knew this didn't bode well. He did a PV. I was only 1cm dilated. He seemed unhappy. It was already about 8 in the evening by now. He decided to rupture membranes to speed things along. He came back to check on me about an hour later. 1 and a half centimetres. I knew he would soon try to sell me a caesar. He started talking about how I should have progressed much further by now and started throwing around phrases like "big baby" and "malposition of the head". Then it came: he said that we could either wait and see or we could just call it quits and go for the caesar then. We told him we'd wait.<br /><br />He decided to go home and asked the midwife to check my progress in about another hour. My partner and I discussed the situation. I felt he should only check on me in another 4 hrs seeing how I was still in passive labour. We both knew there wouldn't be much change in an hour. We knew he would try to coerce us into taking the caesar.<br /><br />After about an hour, the midwife came to check on me. No change. She called the gynae. She came back with the message. He had given it a chance but I was not progressing so he would book theatre for a caesar. I said no. I told the midwife that as far as I was concerned there was no rush. I was still in passive labour and doing fine and the baby was being monitored and she was fine. If anything went wrong, we would know immediately and then we'd agree to a caesar, no question, but right now, there was no need for it and we were happy to wait.<br /><br />She seemed to agree with me but said she'd give us time to discuss it.<br /><br />We agreed that there was no reason to have a caesar. My partner decided to call my original gynae (a colleague of his) to cover our bases. He confirmed what we suspected. We turned down the caesar. The midwife relayed this to the gynae and he asked us for a time frame for how long we were willing to wait. It was nearly 11 at night by then. We said we'd wait until 6 in the morning. She came back and said that he'd told her that if nothing had happened by 06h00 he would book theatre. I was still not happy with that and told her that if nothing had happened by then we could discuss it again. She said that would be easy enough to do.<br /><br />We decided to try and get some sleep. I was unable to rest easy though. At about 02h30 the midwife came to check on me again. She said she thought something was happening. She was right: I was 5cm dilated. Relief washed over me (and my partner when he woke up an hour later. He slept slightly better than I did ;) ). <br /><br />By about 05h30 I was fully dilated and the midwife called the gynae. At 05h47 I delivered a perfectly healthy little girl. (He made some remark about how the head must have turned at some stage. Yeah right.)<br /><br />I ended up having an episiotomy and a vacuum extraction as the baby's head remained high, so it wasn't actually an NVD, but at least I escaped having unnecessary major abdominal surgery.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com15tag:blogger.com,1999:blog-4893667773099408963.post-90133055487381733732008-10-23T15:18:00.000-07:002008-11-05T11:00:44.968-08:00It's a girl!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL3NsCPG_wup-KLjQJj_jZ2CypXawImKBzlkkx3lQ-9EqCusxkE7gJenaCkdb87aYBoepYPvYYao0tMiD-FTOnGx-7oAdJExKeQQ1_hidNzeKMBWkghtaEuuvc7uStO6Hv_MbYQro8Ero/s1600-h/TE9S3HCA52Y792CAVTJW3QCAAIMCNFCAV8Q5VDCAH9W3LICABD8OEECAUFB12FCAEAAU8XCAF9MZLZCAL0R8DKCARXPS7WCACI4I6VCAABBXKECA1S7NISCALX8Q60CACEWCBOCA9Z7LPUCAEY4CLHCANBHCVK.jpg"><img id="BLOGGER_PHOTO_ID_5265250382524493122" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 120px; CURSOR: hand; HEIGHT: 120px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL3NsCPG_wup-KLjQJj_jZ2CypXawImKBzlkkx3lQ-9EqCusxkE7gJenaCkdb87aYBoepYPvYYao0tMiD-FTOnGx-7oAdJExKeQQ1_hidNzeKMBWkghtaEuuvc7uStO6Hv_MbYQro8Ero/s320/TE9S3HCA52Y792CAVTJW3QCAAIMCNFCAV8Q5VDCAH9W3LICABD8OEECAUFB12FCAEAAU8XCAF9MZLZCAL0R8DKCARXPS7WCACI4I6VCAABBXKECA1S7NISCALX8Q60CACEWCBOCA9Z7LPUCAEY4CLHCANBHCVK.jpg" border="0" /></a><br /><br /><br />So I've finally given birth, yay! It's a beautiful little girl and she was born yesterday morning :) Quite a story about how it happened but I'll tell it next time. Right now I'm just going to recover and spend time with my family.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com4tag:blogger.com,1999:blog-4893667773099408963.post-33424208154127299512008-10-13T15:03:00.000-07:002008-10-13T15:17:36.544-07:00Family make the worst patientsI'm not sure if this is universal, but in my personal experience and those of my close friends and colleagues, your own family members and close family friends are always the worst patients.<br /><br />Maybe it's because the transition from 'lay person' to doctor happens in front of them so they don't view you as a real doctor, but invariably, when they ask you for advice, they don't take you seriously and they don't bother to take it. It's quite frustrating because you think "why did they bother to ask?" but after a while you just get used to it, shrug your shoulders, shake your head and brush it off.<br /><br />And they tend to be non-compliant. My dad has essential hypertension. He's had it for years. Still, he tends not to take his meds on time and sometimes even skips a few days. Two of my uncles have type II diabetes mellitus yet still continue to eat poor diets, but not only that, all their kids are obese! If I were faced with such a terrible affliction, I'd make damn sure my kids don't get it, but it's like they're making sure their kids do! All advice falls on deaf ears.<br /><br />Then there are the phone calls saying they have x, y and z signs and symptoms. You ask a few questions to guage the severity, but whenever you think it might be something serious and suggest they go see a doctor in person to be examined, they say they don't think it's necessary. So why did they ask you wonder once again? But it's pointless trying to get them to listen to you.<br /><br />And whenever you suggest a certain treatment or specialist, you're invariably faced with "but can't I just do this or use that?". "No" you say. They never listen.<br /><br />A close family friend told me she had a personal problem. "Yes?" I asked and listened. "I have a painful swelling on my vagina", she told me. Knowing her personally, I wasn't keen to examine her, but she gave me enough information for me to make the tentative diagnosis of a Bartholin's abscess. I told her what I suspected the problem was, advised her to see a doctor asap and told her it would have to be cut open. "But can't I just put antiseptic ointment on it?" she asked. "No" I replied. She didn't listen. About 4 days later, in the middle of the night of course, the pain apparently became completely unbearable and her husband had to rush her to casualties. I laughed when I heard this. She was probably seen by some poor casualties officer who wondered why she had waited so long and until the middle of the night. I'd often wondered that myself whilst draining an abscess in the wee hours of the morning, now I seemingly had the answer.<br /><br />But what can you do? They're family, so when they ask, you have to listen and advise, even if you're smiling to yourself knowing they won't listen anyway and wondering once again why they even ask and why you even bother.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com3tag:blogger.com,1999:blog-4893667773099408963.post-67994357637065822972008-10-03T16:43:00.001-07:002008-10-03T16:49:54.931-07:00Birth dayThe time is drawing nigh and I'm actually getting a bit nervous.<br /><br />With my first pregnancy I decided that I didn't want to be one of those annoying women (like many a patient I've seen) who comes in claiming to be in labour, turns out to have a cervix that's 1cm dilated, gets told the true signs of labour and to come back when she's got those but shows up again the next day and is then only 2cm dilated.<br /><br />Maybe it's because I did all my obstetrics in the state, where days are long and beds are few, that I always got annoyed by those women. In private, you probably get admitted if you want to, but in the state, your admission ticket is active labour and nothing less.<br /><br />So I decided, armed with my knowledge, I was going to do everything right. And I did. But things actually went too well. When I showed up at the labour ward, my cervix was 4cm dilated. I got my epidural and then, even though I was a primigravida, within 1 hour I was fully dilated and ready to deliver.<br /><br />So this time around, knowing that the second time everything goes much faster, I'm nervous because I know I have to get to hospital asap!<br /><br />I have great respect for midwives. Most babies can actually be delivered at home by a midwife. A trained midwife though, because although most pregnancies are actually uneventful, when things go wrong, they go very wrong and you want someone who knows what to do and when to get you to a doctor. Having said that, there is no way I'd deliver at home. I know too much and I'm way too paranoid. I want to be in a fully equipped hospital with lots of drugs readily available and a fully trained obstetrician. But I have to get there on time to have that.<br /><br />I always find it amusing in movies and TV when the expectant couple rushes to hospital at the first sign of labour, tearing up the streets, only just making it there in time before the baby pops out, because real labour is nothing like that, but I've really been worried this pregnancy that that might really happen to me.<br /><br />Today I had a few mild contractions. I was pretty sure they were Braxton-Hicks, but when they started coming approximately every hour, I started thinking it might be early labour. Then I started wondering if I should go to the hospital. Like I said, I've already decided to make haste this time, but then I started thinking: how early is too early, even with a history of a previous short labour? Also, I wasn't convinced they were real contractions. So I decided to wait and see. I thought I might be taking a gamble, but it turned out ok because after a few hours they stopped.<br /><br />So in the end it was good I didn't rush off to the hospital because I would have looked like a fool.<br /><br />But now I'm really left with the predicament of how soon I should act.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com5tag:blogger.com,1999:blog-4893667773099408963.post-62122461178544219212008-09-28T14:31:00.001-07:002008-09-28T15:29:40.272-07:00CorruptionCorruption in Africa is widespread. So widespread in fact that most us aren't even suprised by it anymore. Occasionally, however, someone comes along and takes corruption to a whole new shocking level.<br /><br />Just as common as corruption around these parts is the desire for a DG or disability grant. It is highly sought after. Scoring a disability grant is almost like scoring a jackpot to alot of patients around here. It's a strange phenomenon. Even better than getting a DG for a serious illness though, is getting one for no good reason at all.<br /><br />What I am about to say is absolutely true.<br /><br />A group of staff members at a community clinic were caught trying to abuse the social welfare system. In South Africa, the government grants DG's to HIV patients with CD4 counts less than 200. So what these people did was intercept the blood specimens of HIV positive patients who looked very ill and send the blood away for a CD4 count under their own names. In this way, they had a legitimate record of a very low CD4 count which qualified them for a DG.<br /><br />Fortunately though, the actual application for a DG has to be filled in by a doctor (usually one who does nothing else but that) and when one of these people approached one, he was suspicious of a very healthy looking person supposedly having such a low CD4 count. In this way, this person and eventually all of them were caught out. They even received disciplinary action. Now that's something that's rare in Africa.amanzimtotihttp://www.blogger.com/profile/00547897825508141342noreply@blogger.com5