LESSONS LEARNED FROM RAMADHAN
1). TO BE A GOOD TIME MANAGER....
Ramadhan has taught me to be an excellent time manager. The 5 obligatory prayers plus many more prayers have to be prayed in this holy month, some in the middle of the night or very early before 4a.m yet we are still expected to do our service at our places of work with utmost diligence because diligence at work is also a form of worship. We also expected to read the Quran as much as possible and do dhikr(devotion).The trick to this is being a good time-keepers and planner.3 Sleeping time has to be pre-planned and pre-calculated to fit the schedule, no more wasting time lazing around, T.V time is strictly for news only and Islamic channels because the time is very minimal, traveling has to be pre-planned to fit prayer schedules at different mosques on the way e.t.c. 24 hours are so less.
2). IBADA(WORSHIP) INCLUDES GIVING MY BEST
I can't afford to be harsh to anyone or treat a patient half-heartedly because giving our best is considered a form of worship which is very crucial in life and mostly in this holy month. Hurting someone could make ones fast null and void. Giving substandard services yet you are drawing a salary could be considered sinful.
3). INTER-PERSONAL SKILLS ENHANCED
My communication skills and relationship with my colleagues has greatly enhanced. I have to be careful how I talk to people to avoid hurting anyone, there is no space for talking ill or complaining about anyone, I have learned that direct, firm yet friendly confrontation is the best approach.
4). ALL MY SENSES ARE IN FASTING MODE
EYES- I can't watch things that are detrimental to my spirituality and personality. Islam teaches us to lower our gaze even on the roads.
EARS- listening to gossip, unnecessary talks, bad music etc is a NO NO NO ( not that I listened to these before anyway!)
MOUTH- what comes out of my mouth should not hurt anyone but should instead be a blessing to them and if possible be in the path of worshipping Allah in one form or another.
5). THE ART OF GIVING.
The whole idea behind fasting is to be able to give back to the society. Nobody slept hungry or suffered because of giving to the less fortunate. Giving should be as secret as possible because giving is not meant to be for show-off but for the sake of Allah. The Quran says that what the right hand gives, the left hand should not know about it.
6). MODESTY
Ramadhan has a way of drawing people back to being modest. Modesty in form of ones behaviour, dress-code, talk etc. People might judge but that's one of the purposes of Ramadhan, to draw people back to their creator.
7). IT'S OKAY TO 'UGLY UP'
I am rocking dark eye bags and I'm proud of it. If we can trans-night studying to pass exams or do crazy night calls in the hospital , then surely we can sacrifice for Allah; waking up very early e.t.c. I'm in constant contact with water more than the 5 obligatory times, but that's okay. Natural face with no foundation on is the way to go, so I realize.
8). HEALTHY EATING
Ramadhan has a way of 'shrinking' ones stomach. No matter how gluttonous you are, you can't eat much. A bite or two and fruits is almost always enough. We are also prohibited from eating much Iftar so as to remain light during the long taraweh prayers.
9). HUMILITY
Ramadhan has a way of humbling us. We all become equal. A rich man and a poor man go through the same pangs of hunger, the same prayer sessions, etc. Ramadhan is an equalizer in it's own right.
10). TOLERANCE
If you can tolerate pangs of hunger with a happy face, then trust me you can tolerate anything. I have realized that when treated badly I let it pass unlike in the past where I would whine, hurt, complain etc. There's just a tolerance and peace that comes with Ramadhan that I can't explain.
Sometimes I wish that each of the 365 days of the year was Ramadhan. The joy and peace that comes with Ramadhan is amazing. Everything is always in synchrony worshipping Allah. It's the time of the year when we all get to drop any vices and go back to God fully. I pray that Allah gives us grace to make each and every day of our lives Ramadhan; Amen!! Ramadhan Karim
Monday, 29 June 2015
Sunday, 14 June 2015
WORKING IN COTTOLENGO MISSION HOSPITAL
My experience in Cottolengo Mission Hospital Chaaria
I remember one evening when I was having dinner with younger colleagues in Meru during a KMA meeting, one of the colleagues causally said 'The doctors in Chaaria are quacks.' I was so hurt and shaking from head to toe in anger . I took it so personally and gave him a piece of my mind. I almost shed a tear, I didn't know that I had come to own Chaaria that much. I asked him to go ahead and give me ten reasons why he had generalized Chaaria to be a substandard hospital; he couldn't point on any single reason despite thinking hard. My final conclusion is that he had inherited that ideology from his seniors. He had never been to chaaria, couldn't point at any single patient we had mismanaged yet he had gotten used to the ideology that Chaaria must be substandard because the prices are too cheap. I feel very sorry for the doctors who have refused to change this school of thought. Instead of doing blame games, we would be of much help to the citizenry by having collaborations, consultations and referrals among one another. My boss Dr. Gaido always tells me that our 'Big-Brother' is our patients. They still come despite discouragements from medics in town. They came from as far as Mandera and still spread word for the good job we do.
The first day I took Chaaria seriously was during a KMA meeting when Dr. Gaido announced that he was looking for M.Os to apply for locum chances. My colleagues reminded me that Chaaria was in the middle of nowhere and that no sane lady would make it to locum there. I decided to visit the hospital and keep an open mind. I remember it was a Wednesday afternoon when I made the trip, I found the OPD so full of patients and told myself that if so many patients could make it here while frail and sick then I could also make it for work. The first person I talked to was Senior Clinical-Officer Jonah Gitobu Mworia, I introduced myself and he was very helpful. He showed me a place to sit and asked me to sit and wait for the 'boss'. Dr. Gaido saw me a few minutes later and told me the he instantly trusted me due to my religion and believed that I would not let him down. As planned , I was able to work in the days agreed upon and it wasn't bad at all. While my colleagues back in Meru still complained that it wasn't humanely possible to commute to Chaaria, I was busy making an extra coin and learning a lot at the same time.
When I applied for my annual leave at Meru Hospital, I knew 45 days was a long time to sit at home and do nothing. I was also tired of working in an environment where systems where just not running. Thanks to the county health administration , things at Meru Hospital are much better now. So anyway, despite having an opening at Agakhan Meru, I approached Dr. Gaido and asked him if he could give me a 45 days locum opportunity. He gave it to me without blinking, it was such a relief. During the course of the locum, I came to really love working in Chaaria. I felt that I belonged there. The satisfaction of helping a very poor patient get 1st class health service at a near zero cost was immense. I did the unimaginable among young doctors and decided to apply for a long-term secondment opportunity. Many people called and discouraged me, I was going to get cut off from civilization , that's what they told me. 8 months later, I'm so glad I took the plunge. I'm definitely not the same Khadija. My life has changed, I have gotten so much experience, I have gotten so exposed by working with professionals from Italy, Poland,Britain, Canada etc.
Chaaria is the only mission hospital in Meru that never turns away anyone because they cannot afford admission fees. Service to the poor is really the mission here. We have done major surgeries for patients knowing very well that they wouldn't afford the bear minimal of the cost but we have done what we have to do to save their lives.
I remember one instance, my friend from Meru brought his sister to have a kidney stone removed. The minimal cost he had been charged in Nairobi was 500,000 shillings. I called him and told him that he would pay nothing if he had a NHIF cover. He couldn't believe it. He asked me a few questions just to clarify if it was standard surgery. I reassured him. Because his patient was not covered by NHIF, he paid a total cost of KShs. 6,500 and surgery was successful. Since then he has been a good ambassador to us. He is one man that shuts down those that call us substandard because we are too cheap. Kenyans must change that ideology that cheap is fake. If an organization wants to help, don't start doubting it for being too cheap. Another thing is that our buildings are not as posh, but would you rather be in a posh building and get substandard yet costly service or be in a standard simple room and get 1st class service at a low cost???? Food for thought.
When I asked Dr. Gaido to teach me how to do Hysterectomies, I was scared, I didn't know what to expect. I had been in a system where no one would dare teach you something major for fear of you bringing competition in the private sector. He was very happy with my new interest and taught me very selflessly and patiently. I'll forever be very grateful to him.
One of my patients told me that in his opinion, Chaaria was the prime Cancer Diagnostic Centre in Meru and that I should look for Hon. Julio Mbijiwe and show him our cancer registry and challenge him to ask the County Government to facilitate a monthly visit by an oncologist at Chaaria. I was touched by this view. The patient had visited the Oncology clinic at Meru Hospital and had noted that 98% of the patients there were referrals from Chaaria with referral-letters written by me. So instead of sending the patients there, why not send the doctors to the patients? I hope Hon. Mbijiwe sees this post and does something about this situation. We are the only hospital in Meru doing ultrasound guided biopsies and having an organized histopathology chain.
The road to Chaaria is terrible, totally impassable during the rains. If Chaaria sees a net of 150 patients per day despite the bad road, can you imagine how many more patients we would help if the road was tarmacked. I implore the County Government to take the example of Machakos County and prioritize infrastructure especially if it also opens up a health facility. Hon. Munya are you listening? It just takes three months to tarmack a road 'Mutua-style.'
I could write and write, but Cottolengo Mission Hospital Chaaria has changed my life in so many ways and I'm very grateful for the opportunity to work here. I don't take it for granted. My ideologies have changed, I have become more tolerant and patient, but above all, I have become a better clinician with so much experience that my colleagues can only envy.
I remember one evening when I was having dinner with younger colleagues in Meru during a KMA meeting, one of the colleagues causally said 'The doctors in Chaaria are quacks.' I was so hurt and shaking from head to toe in anger . I took it so personally and gave him a piece of my mind. I almost shed a tear, I didn't know that I had come to own Chaaria that much. I asked him to go ahead and give me ten reasons why he had generalized Chaaria to be a substandard hospital; he couldn't point on any single reason despite thinking hard. My final conclusion is that he had inherited that ideology from his seniors. He had never been to chaaria, couldn't point at any single patient we had mismanaged yet he had gotten used to the ideology that Chaaria must be substandard because the prices are too cheap. I feel very sorry for the doctors who have refused to change this school of thought. Instead of doing blame games, we would be of much help to the citizenry by having collaborations, consultations and referrals among one another. My boss Dr. Gaido always tells me that our 'Big-Brother' is our patients. They still come despite discouragements from medics in town. They came from as far as Mandera and still spread word for the good job we do.
The first day I took Chaaria seriously was during a KMA meeting when Dr. Gaido announced that he was looking for M.Os to apply for locum chances. My colleagues reminded me that Chaaria was in the middle of nowhere and that no sane lady would make it to locum there. I decided to visit the hospital and keep an open mind. I remember it was a Wednesday afternoon when I made the trip, I found the OPD so full of patients and told myself that if so many patients could make it here while frail and sick then I could also make it for work. The first person I talked to was Senior Clinical-Officer Jonah Gitobu Mworia, I introduced myself and he was very helpful. He showed me a place to sit and asked me to sit and wait for the 'boss'. Dr. Gaido saw me a few minutes later and told me the he instantly trusted me due to my religion and believed that I would not let him down. As planned , I was able to work in the days agreed upon and it wasn't bad at all. While my colleagues back in Meru still complained that it wasn't humanely possible to commute to Chaaria, I was busy making an extra coin and learning a lot at the same time.
When I applied for my annual leave at Meru Hospital, I knew 45 days was a long time to sit at home and do nothing. I was also tired of working in an environment where systems where just not running. Thanks to the county health administration , things at Meru Hospital are much better now. So anyway, despite having an opening at Agakhan Meru, I approached Dr. Gaido and asked him if he could give me a 45 days locum opportunity. He gave it to me without blinking, it was such a relief. During the course of the locum, I came to really love working in Chaaria. I felt that I belonged there. The satisfaction of helping a very poor patient get 1st class health service at a near zero cost was immense. I did the unimaginable among young doctors and decided to apply for a long-term secondment opportunity. Many people called and discouraged me, I was going to get cut off from civilization , that's what they told me. 8 months later, I'm so glad I took the plunge. I'm definitely not the same Khadija. My life has changed, I have gotten so much experience, I have gotten so exposed by working with professionals from Italy, Poland,Britain, Canada etc.
Chaaria is the only mission hospital in Meru that never turns away anyone because they cannot afford admission fees. Service to the poor is really the mission here. We have done major surgeries for patients knowing very well that they wouldn't afford the bear minimal of the cost but we have done what we have to do to save their lives.
I remember one instance, my friend from Meru brought his sister to have a kidney stone removed. The minimal cost he had been charged in Nairobi was 500,000 shillings. I called him and told him that he would pay nothing if he had a NHIF cover. He couldn't believe it. He asked me a few questions just to clarify if it was standard surgery. I reassured him. Because his patient was not covered by NHIF, he paid a total cost of KShs. 6,500 and surgery was successful. Since then he has been a good ambassador to us. He is one man that shuts down those that call us substandard because we are too cheap. Kenyans must change that ideology that cheap is fake. If an organization wants to help, don't start doubting it for being too cheap. Another thing is that our buildings are not as posh, but would you rather be in a posh building and get substandard yet costly service or be in a standard simple room and get 1st class service at a low cost???? Food for thought.
When I asked Dr. Gaido to teach me how to do Hysterectomies, I was scared, I didn't know what to expect. I had been in a system where no one would dare teach you something major for fear of you bringing competition in the private sector. He was very happy with my new interest and taught me very selflessly and patiently. I'll forever be very grateful to him.
One of my patients told me that in his opinion, Chaaria was the prime Cancer Diagnostic Centre in Meru and that I should look for Hon. Julio Mbijiwe and show him our cancer registry and challenge him to ask the County Government to facilitate a monthly visit by an oncologist at Chaaria. I was touched by this view. The patient had visited the Oncology clinic at Meru Hospital and had noted that 98% of the patients there were referrals from Chaaria with referral-letters written by me. So instead of sending the patients there, why not send the doctors to the patients? I hope Hon. Mbijiwe sees this post and does something about this situation. We are the only hospital in Meru doing ultrasound guided biopsies and having an organized histopathology chain.
The road to Chaaria is terrible, totally impassable during the rains. If Chaaria sees a net of 150 patients per day despite the bad road, can you imagine how many more patients we would help if the road was tarmacked. I implore the County Government to take the example of Machakos County and prioritize infrastructure especially if it also opens up a health facility. Hon. Munya are you listening? It just takes three months to tarmack a road 'Mutua-style.'
I could write and write, but Cottolengo Mission Hospital Chaaria has changed my life in so many ways and I'm very grateful for the opportunity to work here. I don't take it for granted. My ideologies have changed, I have become more tolerant and patient, but above all, I have become a better clinician with so much experience that my colleagues can only envy.
Tuesday, 26 May 2015
ALCOHOLISM AMONG POST-MENOPAUSAL WOMEN
Alcoholism among post-menopausal women
It would surprise you to note that many of my 'above-50' female patients are chronic alcoholics. I'm following quite a number for Liver Cirrhosis secondary to alcoholism. I see their daughters cry when they open up to me about their mothers drinking behaviour and how they had tried to no avail to help them quit drinking. I have also admitted quite a number in alcoholic coma; drinking till someone passes out completely.
All these women have many things in common. All are above the age of 50, all are widows and only started drinking after the passing of their husbands, all have inherited quite a lot of property and land, all have extremely responsible and well behaved daughters who bring them to hospital and wash them when they pick them from the streets(meaning they were extremely responsible mothers during their productive age).
So what makes them develop this disturbing behaviour? Is it the freedom that suddenly comes with the passing of their husbands? Is it the unlimited control of inherited property? Is it in course of countering the stress that comes with body changes in menopause? Is it the increased loneliness that comes with losing their spouses?Or is it just a mid-50 crisis among women?
I researched on this online to satisfy my curiosity and also to understand my patients better.
The hormonal changes occurring during menopause may lead to uncomfortable emotions. The woman may also have many concerns and fears about what is happening to them such as:
* It is common for women to feel sad because their child bearing years are coming to an end. For many women this will have been an important aspect of their identity
* Menopause is a reminder to women that they are getting older
* The woman can feel less attractive because of the things happening in their body
* They may worry that their low libido due to menopausal changes is going to be permanent
* It is common for women to become easily irritated
* They may feel excessively nostalgic for their younger days and younger bodies
* Women can feel anxious because their body is doing things out of their control like hot flashes and temper fits
* They may experience an identity crisis
Woman use different strategies to help them cope with the emotions of menopause. Unfortunately, some women may turn to negative coping strategies such as alcohol abuse.
So how does one deal with the change that come with menopause.
* Techniques such as meditation are great for helping people cope with stress and anxieties and it can also make it easier to sleep at night.
* Hormone replacement therapy (HRT) mainly estrogen can make a difference for people who are struggling with the symptoms of menopause.
* Night sedatives like Piriton may help people sleep better at night
* Some women may need to begin taking antidepressants if their symptoms are too disruptive. They will need to speak to their psychiatrist or psychologist for this.
* Regular exercise and walking can improve mental and physical symptoms.
* Avoiding spicy food and hot beverages may lead to a reduced incidence of hot flashes.
* Having support groups with their agemates going through the same phase can be a good coping mechanism .
I hope this post helps to highlight a common problem in our society that we have not been keen on. I hope it will help a struggling postmenopausal lady or help the rest of us in the future when our golden years come. Let me know what you think!!!
It would surprise you to note that many of my 'above-50' female patients are chronic alcoholics. I'm following quite a number for Liver Cirrhosis secondary to alcoholism. I see their daughters cry when they open up to me about their mothers drinking behaviour and how they had tried to no avail to help them quit drinking. I have also admitted quite a number in alcoholic coma; drinking till someone passes out completely.
All these women have many things in common. All are above the age of 50, all are widows and only started drinking after the passing of their husbands, all have inherited quite a lot of property and land, all have extremely responsible and well behaved daughters who bring them to hospital and wash them when they pick them from the streets(meaning they were extremely responsible mothers during their productive age).
So what makes them develop this disturbing behaviour? Is it the freedom that suddenly comes with the passing of their husbands? Is it the unlimited control of inherited property? Is it in course of countering the stress that comes with body changes in menopause? Is it the increased loneliness that comes with losing their spouses?Or is it just a mid-50 crisis among women?
I researched on this online to satisfy my curiosity and also to understand my patients better.
The hormonal changes occurring during menopause may lead to uncomfortable emotions. The woman may also have many concerns and fears about what is happening to them such as:
* It is common for women to feel sad because their child bearing years are coming to an end. For many women this will have been an important aspect of their identity
* Menopause is a reminder to women that they are getting older
* The woman can feel less attractive because of the things happening in their body
* They may worry that their low libido due to menopausal changes is going to be permanent
* It is common for women to become easily irritated
* They may feel excessively nostalgic for their younger days and younger bodies
* Women can feel anxious because their body is doing things out of their control like hot flashes and temper fits
* They may experience an identity crisis
Woman use different strategies to help them cope with the emotions of menopause. Unfortunately, some women may turn to negative coping strategies such as alcohol abuse.
So how does one deal with the change that come with menopause.
* Techniques such as meditation are great for helping people cope with stress and anxieties and it can also make it easier to sleep at night.
* Hormone replacement therapy (HRT) mainly estrogen can make a difference for people who are struggling with the symptoms of menopause.
* Night sedatives like Piriton may help people sleep better at night
* Some women may need to begin taking antidepressants if their symptoms are too disruptive. They will need to speak to their psychiatrist or psychologist for this.
* Regular exercise and walking can improve mental and physical symptoms.
* Avoiding spicy food and hot beverages may lead to a reduced incidence of hot flashes.
* Having support groups with their agemates going through the same phase can be a good coping mechanism .
I hope this post helps to highlight a common problem in our society that we have not been keen on. I hope it will help a struggling postmenopausal lady or help the rest of us in the future when our golden years come. Let me know what you think!!!
Wednesday, 20 May 2015
WHAT WOULD YOU DO???? DILEMMA!!!!!
WHAT WOULD YOU DO?
I know that I have been away for a while but I was away in my own world in a journey of self-actualisation, career concentration and personal development.
I have been through a tirade of scenarios while dealing with my patients that have put me in a dilemma and made me wish not to ever be personally in such situations. Mostly we take life for granted and presume many things. There comes a time when you find yourself at crossroads and unable to choose what path to follow.
1). THE AZOSPERMIC PARTNER. Azoospermia is a medical condition in which a man has no spermatozoa at all in his ejaculate fluid. It is mostly irreversible and is a cause of male infertility . I handle such cases atleast once fortnightly. What would you do if found yourself in such a situation? Do you involve the young wife in breaking the news? If you do so, don't you risk having her disrespect her husband and tell everyone in the society putting the man in emotional turmoil?(Remember this is Africa). Isn't it her right to know what is causing infertility in the union and save her from the mean pointing fingers of in-laws? Do you tell the wife and hide it from the husband so that she can secretly look for a child elsewhere and save the marriage?(this only happens in Nigerian movies and is unethical). I have heard cases of men committing suicide due to the stress they go through when their wives 'spread the news.' This is a very tricky situation and I have always tried to handle it with utmost wisdom, privacy and maturity. I let the man do the honors of breaking the news to the wife but I'm sure many of them end up not telling them. A young lady followed me the other day and demanded answers on why I had told her to leave the office and talked to the husband alone. What would you do, as a doctor and as the patient?
2). CANCER IN PREGNANCY. What do you do if you get a patient who has been looking for a child for many years and when she finally gets pregnant she also realizes that she has cancer. Does she carry her pregnancy to term and postpone cancer treatment or does she disregard the pregnancy and carry on with surgery and treatment. If she disregards the treatment, won't the disease be too advanced in 8 months? If she carries on with treatment, what if she doesn't get another pregnancy? WHAT WOULD YOU DO?
3) PRE-CANCEROUS CERVIX AT 30 YEARS
A lady comes in,quite young with an abnormal pap-smear result for pre-cancerous condition . Recently married with only on child. What do you do? Do you do cone-excision of the cervix or remove entire uterus and cervix. She is scared of the condition converting to full blown cervical cancer and insists on Hysterectomy( removal of uterus). However, as a doctor you remind her that she is very young and might need other children or may get re-married later in life. Dilemma! Do you go ahead and do the surgery and risk her regretting in the future? Secondly what if you deny her the surgery and she ends up with cancer later on?
4).THE HUGE GOITRE The patient who comes in with a very big Goitre causing moderate obstruction symptoms. If you don't do surgery, she might end up with severe obstruction of airway later in life. If you do the surgery, she might never wake up from the surgery due to expected collapse of the trachea. What do you do?
5). CANCER IN THE ELDERLY I have seen relatives coming in and insisting on referrals for chemo-radiotherapy for their elderly relatives. How will chemotherapy change the life of a 95year old man with prostate cancer? Won't the effects of the chemotherapy affect the patient gravely more than the cancer itself based on their age and frail bodies? If you don't refer them, the relatives will forever blame you. But this is easy, you refer and shift the burden of blame to the oncologist.
I hope you now appreciate what we go through. The burden of being a decision maker in matters health as well as social. The profession can really get to you. Who said that doctors are not community leaders? Have a nice week ahead. I promise more posts sooner.
1). THE AZOSPERMIC PARTNER. Azoospermia is a medical condition in which a man has no spermatozoa at all in his ejaculate fluid. It is mostly irreversible and is a cause of male infertility . I handle such cases atleast once fortnightly. What would you do if found yourself in such a situation? Do you involve the young wife in breaking the news? If you do so, don't you risk having her disrespect her husband and tell everyone in the society putting the man in emotional turmoil?(Remember this is Africa). Isn't it her right to know what is causing infertility in the union and save her from the mean pointing fingers of in-laws? Do you tell the wife and hide it from the husband so that she can secretly look for a child elsewhere and save the marriage?(this only happens in Nigerian movies and is unethical). I have heard cases of men committing suicide due to the stress they go through when their wives 'spread the news.' This is a very tricky situation and I have always tried to handle it with utmost wisdom, privacy and maturity. I let the man do the honors of breaking the news to the wife but I'm sure many of them end up not telling them. A young lady followed me the other day and demanded answers on why I had told her to leave the office and talked to the husband alone. What would you do, as a doctor and as the patient?
2). CANCER IN PREGNANCY. What do you do if you get a patient who has been looking for a child for many years and when she finally gets pregnant she also realizes that she has cancer. Does she carry her pregnancy to term and postpone cancer treatment or does she disregard the pregnancy and carry on with surgery and treatment. If she disregards the treatment, won't the disease be too advanced in 8 months? If she carries on with treatment, what if she doesn't get another pregnancy? WHAT WOULD YOU DO?
3) PRE-CANCEROUS CERVIX AT 30 YEARS
A lady comes in,quite young with an abnormal pap-smear result for pre-cancerous condition . Recently married with only on child. What do you do? Do you do cone-excision of the cervix or remove entire uterus and cervix. She is scared of the condition converting to full blown cervical cancer and insists on Hysterectomy( removal of uterus). However, as a doctor you remind her that she is very young and might need other children or may get re-married later in life. Dilemma! Do you go ahead and do the surgery and risk her regretting in the future? Secondly what if you deny her the surgery and she ends up with cancer later on?
4).THE HUGE GOITRE The patient who comes in with a very big Goitre causing moderate obstruction symptoms. If you don't do surgery, she might end up with severe obstruction of airway later in life. If you do the surgery, she might never wake up from the surgery due to expected collapse of the trachea. What do you do?
5). CANCER IN THE ELDERLY I have seen relatives coming in and insisting on referrals for chemo-radiotherapy for their elderly relatives. How will chemotherapy change the life of a 95year old man with prostate cancer? Won't the effects of the chemotherapy affect the patient gravely more than the cancer itself based on their age and frail bodies? If you don't refer them, the relatives will forever blame you. But this is easy, you refer and shift the burden of blame to the oncologist.
I hope you now appreciate what we go through. The burden of being a decision maker in matters health as well as social. The profession can really get to you. Who said that doctors are not community leaders? Have a nice week ahead. I promise more posts sooner.
Friday, 10 April 2015
ECTOPIC PREGNANCY, A FAST KILLER
ECTOPIC PREGNANCY
On my usual patient reviews and discussion with my colleague, we went through the case of a pregnant patient who had vaginal bleeding and a regular pelvic ultrasound was done. It showed thickening of the uterus wall and retained products of conception . A diagnosis of incomplete abortion (miscarriage) was done and dilation and curretage done. The patient went home stable, her next review 2 weeks later was unremarkable and she went home happy . Four weeks later, the patient came in with sudden severe abdominal pain and abdominal distension. The abdomen was very tender to touch . And urgent ultrasound was ordered and blood was seen in the abdomen (peritoneum). The uterus was normal and non-gravid , the Fallopian tubes and ovaries were normal. So what is the diagnosis?????? Her pregnancy test remained positive all along. Further scanning of the rest of the abdomen showed an alive 4 months male fetus, with a regular heart beat and movements growing up in the intestines with placenta attached to the large intestine. The placenta had detached slightly and was slowly bleeding. A final diagnosis of ABDOMINAL ECTOPIC PREGNANCY was made and emergency surgery was done just on time and the mother's life was saved. The baby was removed alive but died shorty after due to severe prematurity.
When I was growing up in Machakos, a neighbour lost her life to undiagnosed ruptured ectopic pregnancy. I heard the aunties say that she had lost her life to 'mimba ya mishipa' (pregnancy of the tubes) and it made no sense to me because I thought 'mishipa' only meant 'veins.' 'How can there be pregnancy in the veins?' It confused me at my tender age of 12.
What is ectopic pregnancy? It basically refers to pregnancy that embeds and develops in other places other than the uterus. The most common location is the Fallopian Tubes followed by the Ovaries. The third and least common location is the abdomen as outlined in the first case above.
The causes of ectopic pregnancy are directly related to any factor that causes disruption of the inner lining of the Fallopian tubes and hence delayed passage of a fertilized ovum along the tube. As we all know, fertilization takes place in the tubes then the fertilized egg travels down to implant at the uterus. The factors that cause above disruption include infections of the tubes i.e Salpingitis, chronic inflammation of the tubes as in Tuberculosis of the tubes, abnormalities of the tubes like abnormal lengths and prior tube surgeries. Research shows a high risk in patients with intrauterine copper-T devices for contraception and women who take progesterone only contraceptives. Women with a previous history of ectopic pregnancy are at a higher risk of developing a second ectopic pregnancy.
17 out of 100 women in Kenya will get ectopic pregnancy in their reproductive life. This clearly indicates that incidence is high and that all women of child-bearing age should be armed with knowledge of this very dangerous condition yet very easy to diagnose if proper steps are taken.
The symptoms are usually noticeable latest by 2 months of pregnancy unless in unique cases like the one above. The woman would report missed menstrual periods and severe one sided Lower abdominal pain,irregular minimal vaginal bleeding ( the pain precedes the bleeding), then severe abdominal pains. The patient may present in shock,collapsing , having air-hunger, paleness, rapid heart beat , increased thirst or even unconscious after collapsing. Shock occurs in women undergoing bleeding following a ruptured ectopic pregnancy. Most women are usually not aware that they are pregnant. A ruptured ectopic pregnancy can kill in as little as two hours.
ABDOMINAL PREGNANCY . This happens when the embryo perforates the tube into the abdominal cavity but the amniotic sac remains intact. The embryo continues to grow and a placenta site is established on one of the abdominal structures like the intestines. Pregnancy can continue growing to term but mostly gives way and causes severe bleeding.
I remember watching an Indian medical documentary where a fetus that had stayed in the mother's abdomen for 50 years was removed. It was actually a fetus in the form of mummified stone. This is called a LITHOPAEDION. It occurs when the fetus in an abdominal pregnancy dies, the placenta site thromboses and doesn't bleed, absorption of amniotic fluid occurs and mummification of the fetus occurs by deposition of lime salts. This can stay for many years.
Diagnosis of ectopic pregnancy is mostly clinical through thorough abdominal and per-vaginal examination supported by ultrasound scan and a positive blood pregnancy test in the absence of a fetus in the womb.
Treatment is usually emergency operation to remove the fetus and control the bleeding. The affected tube may be cut ( salpingectomy) and ligated to control bleeding or simply repaired depending on the severity. If the pregnancy is towards the outer end of the tube, it might be milked out if no rupture has occurred to save the tube.
The topic is so wide and intense , I only covered a small portion and I tried to use layman's language as much as possible to sensitize people on this potentially dangerous condition. No mother should lose life to ectopic pregnancy. Spread the word and let me know what you think. Any questions will be answered promptly because I have left a big part to avoid boring you with medical jargon. If you are sexually active and get the above symptoms, seek medical advice quick before it's too late. Thank you
On my usual patient reviews and discussion with my colleague, we went through the case of a pregnant patient who had vaginal bleeding and a regular pelvic ultrasound was done. It showed thickening of the uterus wall and retained products of conception . A diagnosis of incomplete abortion (miscarriage) was done and dilation and curretage done. The patient went home stable, her next review 2 weeks later was unremarkable and she went home happy . Four weeks later, the patient came in with sudden severe abdominal pain and abdominal distension. The abdomen was very tender to touch . And urgent ultrasound was ordered and blood was seen in the abdomen (peritoneum). The uterus was normal and non-gravid , the Fallopian tubes and ovaries were normal. So what is the diagnosis?????? Her pregnancy test remained positive all along. Further scanning of the rest of the abdomen showed an alive 4 months male fetus, with a regular heart beat and movements growing up in the intestines with placenta attached to the large intestine. The placenta had detached slightly and was slowly bleeding. A final diagnosis of ABDOMINAL ECTOPIC PREGNANCY was made and emergency surgery was done just on time and the mother's life was saved. The baby was removed alive but died shorty after due to severe prematurity.
When I was growing up in Machakos, a neighbour lost her life to undiagnosed ruptured ectopic pregnancy. I heard the aunties say that she had lost her life to 'mimba ya mishipa' (pregnancy of the tubes) and it made no sense to me because I thought 'mishipa' only meant 'veins.' 'How can there be pregnancy in the veins?' It confused me at my tender age of 12.
What is ectopic pregnancy? It basically refers to pregnancy that embeds and develops in other places other than the uterus. The most common location is the Fallopian Tubes followed by the Ovaries. The third and least common location is the abdomen as outlined in the first case above.
The causes of ectopic pregnancy are directly related to any factor that causes disruption of the inner lining of the Fallopian tubes and hence delayed passage of a fertilized ovum along the tube. As we all know, fertilization takes place in the tubes then the fertilized egg travels down to implant at the uterus. The factors that cause above disruption include infections of the tubes i.e Salpingitis, chronic inflammation of the tubes as in Tuberculosis of the tubes, abnormalities of the tubes like abnormal lengths and prior tube surgeries. Research shows a high risk in patients with intrauterine copper-T devices for contraception and women who take progesterone only contraceptives. Women with a previous history of ectopic pregnancy are at a higher risk of developing a second ectopic pregnancy.
17 out of 100 women in Kenya will get ectopic pregnancy in their reproductive life. This clearly indicates that incidence is high and that all women of child-bearing age should be armed with knowledge of this very dangerous condition yet very easy to diagnose if proper steps are taken.
The symptoms are usually noticeable latest by 2 months of pregnancy unless in unique cases like the one above. The woman would report missed menstrual periods and severe one sided Lower abdominal pain,irregular minimal vaginal bleeding ( the pain precedes the bleeding), then severe abdominal pains. The patient may present in shock,collapsing , having air-hunger, paleness, rapid heart beat , increased thirst or even unconscious after collapsing. Shock occurs in women undergoing bleeding following a ruptured ectopic pregnancy. Most women are usually not aware that they are pregnant. A ruptured ectopic pregnancy can kill in as little as two hours.
ABDOMINAL PREGNANCY . This happens when the embryo perforates the tube into the abdominal cavity but the amniotic sac remains intact. The embryo continues to grow and a placenta site is established on one of the abdominal structures like the intestines. Pregnancy can continue growing to term but mostly gives way and causes severe bleeding.
I remember watching an Indian medical documentary where a fetus that had stayed in the mother's abdomen for 50 years was removed. It was actually a fetus in the form of mummified stone. This is called a LITHOPAEDION. It occurs when the fetus in an abdominal pregnancy dies, the placenta site thromboses and doesn't bleed, absorption of amniotic fluid occurs and mummification of the fetus occurs by deposition of lime salts. This can stay for many years.
Diagnosis of ectopic pregnancy is mostly clinical through thorough abdominal and per-vaginal examination supported by ultrasound scan and a positive blood pregnancy test in the absence of a fetus in the womb.
Treatment is usually emergency operation to remove the fetus and control the bleeding. The affected tube may be cut ( salpingectomy) and ligated to control bleeding or simply repaired depending on the severity. If the pregnancy is towards the outer end of the tube, it might be milked out if no rupture has occurred to save the tube.
The topic is so wide and intense , I only covered a small portion and I tried to use layman's language as much as possible to sensitize people on this potentially dangerous condition. No mother should lose life to ectopic pregnancy. Spread the word and let me know what you think. Any questions will be answered promptly because I have left a big part to avoid boring you with medical jargon. If you are sexually active and get the above symptoms, seek medical advice quick before it's too late. Thank you
Friday, 27 March 2015
THE FIBROIDS MENACE
FIBROIDS
Fibroids have become a real medical dilemma especially among us career women who get into the family way very late either in the mid 30s or early 40s. I have seen patients who have come in and narrated to me how fibroids have totally messed up their lives.
So what exactly is fibroids?? Fibroids or fibromyomas are the most common tumors of the human body. They arise from the muscular wall of the uterus(womb). Their Growth is due to action of the hormone estrogen. They arise during period of menstrual activity and are mostly found in nulliparous women( those who have never had children) or women who have not been pregnant for sometime. They are mostly found in black women and tend to favor infertility and miscarriage due to distortion of uterus cavity.
There are 4 main types of fibroids. Interstitial,Subperitoneal,Subendometrial and Cervical. This categorization is based on their locations ; within the wall of the uterus, arising from the outer layer of the uterus, arising from the inner layer of the uterus and from the Lower part respectively. The subendometrial ones are most notorious for causing miscarriages, the interstitial ones cause abnormally heavy menstrual bleeding and the cervical ones may cause obstruction of labour during normal delivery.
Fibroids tend to grow more during pregnancy and to shrink or atrophy during the post-menopausal period.
Patients present with a wide variety of symptoms depending on the size and type of fibroids. These include; an abdominal mass, Increase in duration and amount of menses,Offensive discharge( if a subendometrial fibroid is undergoing necrosis), Late menopause, Abdominal pains which may be accompanied by vomiting( in case of degeneration of fibroids),Frequent urination and retention of urine (if the fibroids are too big), Infertility,Frequent abortions, Labour obstruction, Mass protruding from the vagina etc.
Fibroids are diagnosed by doing ultrasound scans. Small fibroids that are not causing symptoms do not require treatment but big or symptomatic tumors require surgical removal. Indications for surgery include heavy or prolonged bleeding, large tumors most likely to cause urinary symptoms, fibroids causing infertility or miscarriages, fibroids that are likely to obstruct labour and fibroids that tend to increase in size after menopause( these are most likely to get malignant change) e.t.c
Surgery can either be removal of the fibroids or total removal of the uterus depending on the patients need to conceive in the future. Sometimes a surgeon can go in with intention of removing the fibroids only to end up removing the entire uterus if bleeding is uncontrollable during the procedure.
Is there a way to avoid fibroids? Not really!! Remember fibroids also run in families. We can probably avoid them by getting children early ; this way, even if fibroids eventually come , there will be no harm in removing the uterus.
I'm not against career progress among women, but a 2 year sacrifice to get babies can help a lot in avoiding the fibroid menace and consequences.( I can hear my mother saying AMEN to this). I however agree that other factors are to be considered too. Let me know if this post was educative.
Fibroids have become a real medical dilemma especially among us career women who get into the family way very late either in the mid 30s or early 40s. I have seen patients who have come in and narrated to me how fibroids have totally messed up their lives.
So what exactly is fibroids?? Fibroids or fibromyomas are the most common tumors of the human body. They arise from the muscular wall of the uterus(womb). Their Growth is due to action of the hormone estrogen. They arise during period of menstrual activity and are mostly found in nulliparous women( those who have never had children) or women who have not been pregnant for sometime. They are mostly found in black women and tend to favor infertility and miscarriage due to distortion of uterus cavity.
There are 4 main types of fibroids. Interstitial,Subperitoneal,Subendometrial and Cervical. This categorization is based on their locations ; within the wall of the uterus, arising from the outer layer of the uterus, arising from the inner layer of the uterus and from the Lower part respectively. The subendometrial ones are most notorious for causing miscarriages, the interstitial ones cause abnormally heavy menstrual bleeding and the cervical ones may cause obstruction of labour during normal delivery.
Fibroids tend to grow more during pregnancy and to shrink or atrophy during the post-menopausal period.
Patients present with a wide variety of symptoms depending on the size and type of fibroids. These include; an abdominal mass, Increase in duration and amount of menses,Offensive discharge( if a subendometrial fibroid is undergoing necrosis), Late menopause, Abdominal pains which may be accompanied by vomiting( in case of degeneration of fibroids),Frequent urination and retention of urine (if the fibroids are too big), Infertility,Frequent abortions, Labour obstruction, Mass protruding from the vagina etc.
Fibroids are diagnosed by doing ultrasound scans. Small fibroids that are not causing symptoms do not require treatment but big or symptomatic tumors require surgical removal. Indications for surgery include heavy or prolonged bleeding, large tumors most likely to cause urinary symptoms, fibroids causing infertility or miscarriages, fibroids that are likely to obstruct labour and fibroids that tend to increase in size after menopause( these are most likely to get malignant change) e.t.c
Surgery can either be removal of the fibroids or total removal of the uterus depending on the patients need to conceive in the future. Sometimes a surgeon can go in with intention of removing the fibroids only to end up removing the entire uterus if bleeding is uncontrollable during the procedure.
Is there a way to avoid fibroids? Not really!! Remember fibroids also run in families. We can probably avoid them by getting children early ; this way, even if fibroids eventually come , there will be no harm in removing the uterus.
I'm not against career progress among women, but a 2 year sacrifice to get babies can help a lot in avoiding the fibroid menace and consequences.( I can hear my mother saying AMEN to this). I however agree that other factors are to be considered too. Let me know if this post was educative.
Saturday, 14 March 2015
WHEN DOCTORS LIE
This morning, I woke up to read the Paul Kalanithi story. He was a top neurosurgeon at Stanford who succumbed to metastatic lung cancer at the age of 37 earlier this month. He had written numerous essays, “How Long Have I Got Left?” for The New York Times and “Before I Go” for Stanford Medicine, reflected his insights on grappling with mortality, his changing perception of time and the meaning he continued to experience despite his illness.
He closed his Stanford Medicine essay with words for his infant daughter: “When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”
His story makes me reflect on how doctors, me included, deny patients the truth on the magnitude of their illness and the chance to prepare and face their last days appropriately. I remember the case of X who we had operated on and found that her cancer had spread everywhere in the abdomen and everything was matted together so we couldn't resect the tumor. When she came in to pick her biopsy results I told her the truth but not the whole truth. I did tell her that she had cancer but the look she gave me was so depressing and stressful that I decided to give her 'hope' and lie that we had removed the tumor and that all she would need was intervention in a cancer unit and the disease would go into remission if adequately handled. I figured out that if I broke the news as they are, depression would kill her faster than the illness. I basically left the task of disclosure to the oncologist.
By reading the Kalanithi story, I realize that most of us deny our patients the chance to prepare for their last days. Some relatives even sneak in ahead of their patients and beg me to hide the truth and not to disclose to their patients that they have an end-stage illness. Others practically wink at me when they realize that I'm almost disclosing the disease to their sick relatives. We doctors lie in so many ways. I remember the case of 'Z' who was battling an unresectable brain tumor that was fast growing. Instead of the doctors in Kenyatta telling him the truth, they told him to go home and wait for their call on when to go for surgery. The family remained hopeful and kept on spending so much money taking him from hospital to hospital to make him 'stable for surgery' because they thought Kenyatta would call in anytime. Three months into the illness and they did not call making the patient hopeful only for him to succumb to the illness. I believe that had the truth been told, adequate preparation and coming to terms with the illness would have been made. Sometimes we even write palliative care referrals for the last-stage patients and lie to them that palliation is highly intensive treatment for metastatic cancer while in essence palliation is basically making the patient comfortable in the last days.
Kalanithi talked about the importance of proper communication and disclosure of the whole truth in a gentle manner. His ‘dual citizenship’ as a doctor and as a seriously ill patient had taught him that respectful communication is the bedrock of all medicine. I now know and appreciate the importance of proper disclosure. It might stress the patient but with time they do come into terms with it and prepare for their illness and impending mortality adequately and with bravery.Had Paul Kalanithi not known the truth about his illness, he would have probably not planned for the conception and birth of his daughter into his illness.
You would be surprised at how strong some patients are.
The truth hurts but it is better than giving colorful lies
His story makes me reflect on how doctors, me included, deny patients the truth on the magnitude of their illness and the chance to prepare and face their last days appropriately. I remember the case of X who we had operated on and found that her cancer had spread everywhere in the abdomen and everything was matted together so we couldn't resect the tumor. When she came in to pick her biopsy results I told her the truth but not the whole truth. I did tell her that she had cancer but the look she gave me was so depressing and stressful that I decided to give her 'hope' and lie that we had removed the tumor and that all she would need was intervention in a cancer unit and the disease would go into remission if adequately handled. I figured out that if I broke the news as they are, depression would kill her faster than the illness. I basically left the task of disclosure to the oncologist.
By reading the Kalanithi story, I realize that most of us deny our patients the chance to prepare for their last days. Some relatives even sneak in ahead of their patients and beg me to hide the truth and not to disclose to their patients that they have an end-stage illness. Others practically wink at me when they realize that I'm almost disclosing the disease to their sick relatives. We doctors lie in so many ways. I remember the case of 'Z' who was battling an unresectable brain tumor that was fast growing. Instead of the doctors in Kenyatta telling him the truth, they told him to go home and wait for their call on when to go for surgery. The family remained hopeful and kept on spending so much money taking him from hospital to hospital to make him 'stable for surgery' because they thought Kenyatta would call in anytime. Three months into the illness and they did not call making the patient hopeful only for him to succumb to the illness. I believe that had the truth been told, adequate preparation and coming to terms with the illness would have been made. Sometimes we even write palliative care referrals for the last-stage patients and lie to them that palliation is highly intensive treatment for metastatic cancer while in essence palliation is basically making the patient comfortable in the last days.
Kalanithi talked about the importance of proper communication and disclosure of the whole truth in a gentle manner. His ‘dual citizenship’ as a doctor and as a seriously ill patient had taught him that respectful communication is the bedrock of all medicine. I now know and appreciate the importance of proper disclosure. It might stress the patient but with time they do come into terms with it and prepare for their illness and impending mortality adequately and with bravery.Had Paul Kalanithi not known the truth about his illness, he would have probably not planned for the conception and birth of his daughter into his illness.
You would be surprised at how strong some patients are.
The truth hurts but it is better than giving colorful lies
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