Sometime back a patient presented in emergency with complaint of bleeding from an ulcer in breast and severe backache. As is typical she was referred from community health center in nearby town coming to us at 2:00 A.M. She appeared not to be worried about the lump in her breast or the multiple swellings in her axilla and other areas in her body ( she had metastasis and satellite nodules as well) but about the bleed from her ulcer. The surprising thing was that she is from well to do family and quite educated. In fact she did consult a doctor three years back who had advised mammogram and FNAC which had been inconclusive. She was asked to undergo a biopsy which she found bothersome and turned to home remedies/ ayurveda/ unani for treatment till now.
The sad part is that even her relatives are under the impression that she is fine. Her appetite is good; hasn’t lost weight hence must be healthy. “Doctor just give her some glucose (i.v. fluids) and blood and she will be fine” is what they say.
This is not the first time i have seen case of terminal cancer, but to go this way without trying is sad.
In our hospital (and i suppose in India in general) a large proportion of patients of Breast cancer present very late in the disease process. Mostly this is due to lack of awareness and access to medical facilities. The patients comes to the doctor only when the lump or discharge is noticed by friend or family member and forced to seek medical care. there is astonishing amount of ignorance and shame associated with the disease. This is the case not just in cancer but even more so in gynecological malignancies. I find patients are much more prompt in seeking care for abdominal or respiratory complaints.
A 2 year old girl with eight limbs undergoes surgery in Bangalore. Read the news from bbc
Lakshmi was born two years ago on Diwali in Araria village in Bihar. Although the people of the village treated her as a re-incarnation of Goddess Lakshmi, for doctors she was an ischiopagus conjoined twin.
Update: The operation was successfully completed in 27 hours. Read the rest of the story with photos here
reupdated: Lakshmi is doing fine following surgery further news
Lakshmi is deemed fit enough to go home following surgery. She may require further surgery later to enable her to walk properly.
“Lakshmi has recovered adequately with no significant problem during her process of recovery. Her parents are keen to take her home and medically she can do so,” Dr Sharan Patil, who headed the team that performed the rare surgery on Lakshmi on November 6, announced at a news conference.
the full story.
If romantic fiction is any guide, any doctor looking for love would be advised to be an emergency room surgeon or deliver babies rather than practise colon resection or remove in-grown toenails.
So says Irish Psychiatrist Brendan Kelly, who has probed at length into the burgeoning literary field of medical romance.
In an offbeat letter published in Saturday’s Lancet, Kelly describes the typical plot structure and characterization ( the Lancet-reg required)
As for the storyline, novelists skirted such hazards as malpractice suits for removing the wrong kidney or infection by a hospital superbug.(too hum drum?)
Instead, they stuck to a tried-and-trusted formula of the doctor as a saviour in a white coat.
How does he do it? Is he reading these books while patients pour out their woes?
According to the latest ORG survey Diclofenac painkiller brand Voveran is the most used drug in India displacing cough medications which till now were the topmost brand. This has already been the trend in other markets. One not so surprising drug in the topmost brand is Liv 52 an ayurvedic preparation from Himalaya. As reported in the Times of India.
Last year, cough syrup Phensydyl marketed by Nicholas Piramal, was the top brand, followed by another cough syrup Corex. The second largest brand for the January-July period is Corex (Pfizer), followed by ayurvedic liver tonic Liv-52 (Himalaya), anti-diabetic Human Mixtard (Abbott) and lastly, Phensydyl.
Industry experts attribute the spurt in sales of Voveran due to rise in viral fever this year. Doctors often prescribe pain medications to address bodyache, a common phenomenon of viral infections.
Last year, growth in therapeutic segments such as anti-infectives was robust on the backdrop of episodes like chikungunya, scares of bird flu and dengue, while this year cases of viral infections have been more rampant.
I think this trend will continue. As for the use of ayurvedic preparations like candy by allopathic practitioners the less said the better..
Technorati Tags: pharma, painkiller,
In a very busy emergency we were attending to a RTA (road traffic accident) victim having serious head injuries and other multiple injuries in terminal condition; totally ignoring a drunk having minor injuries who was waiting for his turn for a while. After hanging around observing his comment was- ” If he had been wearing his helmet he would be waiting for his turn after me.”
Actual conversation (translated from Hindi) with a patient having Gastritis.
Me: So what brings you here.
He: I came by bus.
Me: No, No. Whats your complaint?
He: My wife; she sent me.
Now the situation was begging for a leading question so-
Me: You are having abdominal pain?
He: Oooh yes. and then the rest followed..
Wonder what it was with dogs last week. Attended no less than seven or eight cases of dog bite in a single day. all shape and categories. Most didn’t require much other than cleaning of wounds and advise regarding vaccination and antibiotics. The situation of rabies being what it is in our country I always advise both active and passive immunization in cases of severe injuries.
Department of Animal Biotechnology, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai-600 007.
A pilot survey of the dog population and rabies vaccination in India.
Biomedicine. 1997; 17(1): 25-7
ABSTRACT: A pilot survey of the dog population and the status of rabies vaccination was conducted by using a questionnaire prescribed by the World Health Organization in a suburban area to determine the size and structure of the dog population and its level of rabies vaccination. There was a ratio of 1:19.23 dog to human and the mean number of dogs per household was 1:11. The level of rabies vaccination was 39,1 percent. With the rabies incidence in India still unacceptably high this level of vaccination is clearly inadequate and measures designed to increase the rate of vaccination are emphasized.
Dog Diseases/PC; Rabies/VE; Vaccination/VE; Rabies/PC; Population Dynamics; Animal; Dogs; Data Collection
Record Identifier: NI004243
One seven year old bitten by the village dog was in really bad shape with large laceration over scalp and part of skin torn away. The wound was repaired primarily after debridement and a little bit of mobilization. I reexamined the wound today and it has healed quite well. Great!
I have seen a few cases of rabies and I can tell you it is mind numbing and disturbing. The future remains grim.
This week I attended a court for summon as a witness. I had treated a person who was assaulted by his neighbour for some petty reason about 4 years back. No great damage – a few laceration and abrasions which I had stitched and dressed and subsequently discharging him the same day. Armed with the copy of summon I presented myself to the court clerk. The case came up just after the lunch recess and I didn’t have to wait much.The hearing was all very pleasant and expeditious. I had previously given an opinion regarding the injuries sustained in writing, which was already submitted. I confirmed it to be my opinion under oath. Minimal amount of cross questions by either lawyer and I was on my way back in less than an hour.
On an average in a week I have to deal with 22 to 25 such cases; and it has been so since last so many years. I have already attended a few of these summons previously but the frequency has increased recently. Besides these cases there are about 7-8 cases in a week of stab injuries, hemothorax / pneumothorax following assault or firearm injuries which are â€˜Seriousâ€™; I wonder where all these will lead to? Will I be spending a major portion of time in Court houses; I wonder.
Despite what is in the textbooks Dengue patients do not always develop rashes till the platelet levels have fallen waay down and even then hemorrhage may be sudden. Today i saw a patient in emergency who was complaining of pain in right upper abdomen and had fever for last 2 days. I had a suspicion of liver abscess and to confirm i got a ultrasound examination done. The radiologist found inflammation of gallbladder without any stones suggestive of dengue and it was confirmed as such. Quite a number of patients present with upper abdominal pain with fever and it has happened quite a few times that on clinical examination i have suspicion of Acute cholecystitis which on ultrasound examination is suggestive of dengue and later confirmed as such. Discussion of dengue from surgical point of view can be seen here .
There i was minding my own business- lurking through this blog when i came across this post regarding Radiohead experiment in music retail. It is a great experiment and i hope it works out well for them. They leave the price to be paid totally upto you. I checked it out for myself- didn’t buy though. Maybe you will…