A Doctor's "Secret" Notes

New Look Blog

2012-05-04T00:39:00.003+02:00

Hello people,

This health blog, as slow-paced at it's been for a while now, has taken a whole new look - the "dynamic view" option from Google's blogger. I had to go with this option for the reason of the ability to access all the new add-on features which I plan to utilize to enhance the blog in due course.

Anyway, I'll be back to making entries from my scheduled clinical activities, soon.

Artemisinin-Based Combination Therapy

2012-04-15T01:14:00.000+02:00

With Malaria still wreaking havoc across this part of the world where I live and practice medicine – and I’m talking a mortality rate of about 1 million deaths per annum, mainly children – the management and preventive practices thereof, is certainly of importance to me and my colleagues where I work.

This male patient had been treated on two seperate occassions but still had fever and the characteristic evening chills of Malaria. He had complied well with the ACT- Artemisinine-based combination therapy – medication given, taking the right dose at the appropriate time, so he had said. So why was he still symptomatic? Could it have been a misdiagnosis, I wondered.

Well, I sent him to the laboratory for a full blood work-up.

The Year of The TRÉVOLUTION

2012-04-13T02:39:00.002+02:00

Long time I've neglected this health-diary of mine, sorry people. Obviously, this is my first post this year, so... Happy New Year-of-the-TRÉVOLUTION!

It's something new. Something I've bought whole-heartedly into and so I'm promoting it everywhere.

It will make me wealthy, hopefully, through its compensation plan - I'll make no secret about that. Bought into it also to keep my family and I well armed to stay optimal in health from the point of view of it's supply to our body systems, of every known major nutritional metabolite - including herbs the world over, researched upon - all packaged in a bottled liquid, researched formulation.

Sounds like some product promo, right? Well sure, I'm in it and so I'm promoting it. I believe in it professionally.

Join the TRÉVOLUTION! ...oh, and, it's never too late to say it people - Happy New Year!

Mental Health Challenged

2011-10-13T01:23:00.000+02:00

I recall the event in 2009 Christmas time, when a Nigerian man's pants alighted in flames as he sat in a plane en route to some state in the US - it was a botched attempt of his to blow-up the plane and cause the certain deaths of all on board.

I've had a middle-aged female, dear to her relations, recently on admission on account of her Psychotic delusions which causes her the false belief that she is the pilot of a space-craft who's hotly pursued by agents determined to terminate her life! She would often scream-out, her face twisted in fear; her whole body contorted, as if taking desperate measures within the cockpit of that space-craft conceived in her deluded mind.

While of course my psychotic patient is simply challenged in terms of her mental health, the same can not be said of the famed Christmas bomber - my fellow country man, sad to say, by the way. His may be viewed as a case of, well... being brain-washed; muddled-up political ideology-wise... Or why else would anyone resort to the mass killing of innocent lives for whatever reasons.

The Republican Tea-Party Express!

2011-09-13T04:52:00.002+02:00

The CNN presented Republican Tea-party express debates just ended - why call it the Tea-party express when clearly not all of the candidates are from that radical GOP base - and it was quite entertaining indeed. All the jostling and back-stabbing for political points especially those trailing in the polls...

I've been busy all week on the job - many complicated surgical cases - and Obstetrics ones as well.

And, Nadal lost to Novack Jochovic - hope I spelt that one's name right - and that really got to me as I'm a great fan of Rafa.

Blog Neglect Blues... Herniorrhaphy That Went Like The Breeze.

2011-08-18T04:16:00.001+02:00

I feel bad having not posted a single health gist or any sort of matter at all on this blog for a long, long while. And I cannot think of a good enough excuse that could justify this huge neglect. Except perhaps to promise you that my life in the past months had been roller-coaster like indeed, often having to multi-task in a not so well-coordinated manner - but then, doesn't that just describe the average human Joe or Jide that's surviving on todays planet Earth!

I performed a Herniorrhapphy today that went like the breeze - quick-paced with little to no hitches. I started by utililizing local anaesthetic, then, after finding the hernial sac, finished off with Ketamine intravenous anaesthesia.

Cancer, Right Breast

2011-04-05T05:38:00.000+02:00

I'm somewhat in-human it seems when mechanically, I go about on the job, some of the time. Or to put it more aptly, more detached from the normal feelings lay persons would feel at certain instances.

This of course comes with the terrain and in spite of sometimes having short spells of feeling besides myself, it's become second nature to me.

These were my fleeting thoughts as I dressed the extensively sutured wound, left behind on the chest-wall of the 54-year old, after her right breast and all of the relevant surrounding tissues had been surgically removed completely, nine days back. She would wince and cry-out softly whenever I dabbed with EUSOL gauze.

For many years she had suffered cancer of the right breast up until surgery. And a radical mastectomy indeed it was, that had been the procedure at theatre - leaving no room, hopefully, for any metastasised cancer cells to remain present. Now, she was able to move her right arm with less pain since after surgery, exercising her right shoulder through slow motions as I tended to her surgical wound, while she moaned in painful protestations occasionally punctuated by quick, thankful words from her mouth, for her salvaged situation.

I may have mumbled a few words back at her.

I was on full-throttle mechanical mode, with several cases still waiting to be attended to by me at the out-patients, downstairs.

Surviving

2011-03-14T02:31:00.003+01:00

Yes, as a privately owned medical centre, we seem to be coping and staying afloat, even after the tragic demise of my maverick, late boss.

So, here we have been over the last several months thence, a health facility in the business of saving lives, ourselves desperately trying to survive amidst the realities of a harsh economic environment, bereft of our strongman - the boss - who held things in sway the way that only he could.

We are still delivering newly born babies, managing medical condition after condition and yes, going ever so often to the surgical theatre, such as was the case today - a surgical skin grafting procedure in a young man with Sickle Cell Disease, with a huge ulcer on the sole of his left foot. It took many patient days for that ulcer to granulate, thus looking bleeding-red and ready for the donor skin to properly "take". Let's hope over the next several days that a good "take", it surely will.

It's good to be back health-blogging, by the way, let me tell you.

Demise of A Medical Guru

2010-12-03T22:29:00.001+01:00

Morale has been low for three weeks stretch, where I work, after my M.D's untimely demise.

It indeed was a rude shock when the big man left the Stage and it's hard really, coming to full terms with the true meaning of his exit.

About the most resourceful private medical practitioner I've had the priviledge of knowing, he is being sorely missed by a whole lot of folks, I inclusive.

RIP, oga.

Zero About Health

2010-10-28T01:18:00.000+02:00

I absolutely have nothing noteworthy to post on this health blog of late. I'm a bit tired of the same old yarns about this sickness or that treatment procedure. I feel I need to shake things up a bit.

A couple of Appendectomies and one Hydrocelectomy - in a 3-year-old boy - I did perform recently. And the world is not exactly a better place as a result.

Anyway, I'll be catching-up later. I guess.

Health Risk - Lady With Two Previous Caesareans In Active Labour

2010-10-11T23:11:00.002+02:00

nf233/Secret/Confidential/Health

She was billed for an elective procedure in 6 days. Already booked and remaining healthy while attending antenatal clinic, she had had two previous Caesarean Sections. Attempting a vaginal birth now, would pose a health risk.

And a health risk she now faced, when quite suddenly she began having strong uterine contractions and draining liquor. An Emergency Caesarean Section is her safest option now. Her health and the health of her unborn baby, is best safe-guarded thereby. I updated Dr Nsisi and soon left.

My duty had ended. So I'll hear the outcome of the health of the duo, later.

Serpentine Health Monster

2010-10-11T00:17:00.000+02:00

nf232/Secret/Confidential/Health

The inflamed, near-gangrenous appendix, finally reared its smelly tip to the surface. Dr Nsisi and I (I as assistant) had battled courageously with this serpentine health monster.

And a battle it was indeed. Not of physical strength of course, but of wits. It had been tricky ensuring that the appendix didn't rupture - this would have meant worsened health. And, optimizing the patient's health after all, was the objective of the difficult surgery. Optimizing patients' health is indeed the objective of all health workers in the health team.

That was two days back.

Let me wish you all a healthy weekend, even as I relax on my weekend off-duty. More health challenges on the job would undoubtedly resume shortly.

Search Engine Optimization - "Health" Is Key

2010-10-10T23:52:00.000+02:00

nf231/Secret/Confidential/Health

Search Engine Optimization (SEO). That's the name of the game I'm faced with in trying to keep up the health of this here health-blog to the optimum. That is, assuming the health of any blog is adjudged by the level of traffic it receives.

So here I am, a medical doctor, spending short bursts of time online every now and again, in trying to run a health-blog, blogging about health happenings on the job, thinking may be there's an audience that cares out there - and so I try to optimize the health of this health-blog the more.

Notice I input the word "health" here and there. That's my key word. I'm learning. Just one of the tricks in SEO. Notice too, the newly added word in this blog's title, A Doctor's "Secret" Notes -"Health".

That's SEO for you.

Intravenous Line For A Week-Old Neonate

2010-10-07T21:09:00.002+02:00

The child had a very high fever by the time I was examining it in the consulting room late in the afternoon. The parents had arrived with the neonate in the dad's arms - they both behaved calmly; I must commend them. For, the child was certainly irritable - wailing and squirming all over the place.

It was a case of Neonatal Sepsis, likely from an infected umbilical cord and I promptly entered the treatment plan then shortly after settled down to secure an intravenous line through which the needed intravenous antibiotics would be administered.

Both parents milled around me attentively as I sat by the child lying on the bed. I seized its tiny limb in my grip - tourniquet in place - in search of any visible, distended veins; the intravenous cannula and other utensils within reach. I was appreciative of the calm and quiet attitude I received from the young couple; their one-week old child crying ceaselessly. I got lucky on the first attempt.

Hopefully, a couple of days admission or so, would see the neonate off home to continue antibiotic syrups for sure.

#1 On Google For "Personal" Health Blog!

2010-10-01T21:31:00.000+02:00

I've been neglecting this blog. It's the result of several things combined - I've been busy getting more adept at ways to improve my blog-traffic, and other stuff I'm busy doing.

Updates on the job:
While I've been "away" we've had to surgically remove the womb (Uterus) of a patient who had intractable bleeding, secondary to Uterine Fibroid - the surgery, a Total Hysterectomy, was a huge success: I mean, here was a woman who had been absolutely miserable all week long due to pain and pallor, as we built her up towards the procedure, who now is so calm and full of smiles 2-days post-operation. I assisted a very experienced Gynaecologist I've known for over a decade and it was endless banter all the way - I was his house-officer back in the day.

Anyway, back to trying to be Google's health-blog-number-one. I've been doing this and that. Matter of fact, I have to go back now to continue!

Episiotomy-Assisted Vaginal Birth

2010-09-26T15:32:00.002+02:00

I just recently delivered a woman of her third baby - a baby girl. I had been called to see an out-patient arrival and so was headed for the consulting room, when I heard the screams coming from upstairs and so I detoured.

The baby's head was already crowned - you could see locks of hair and scalp right at the introitus (vaginal entrance) even during the relaxation phase of uterine contractions. She was tense and fidgety at this final phase of the 2nd stage of labour - I've noticed sometimes, our midwives do not do a good enough job of managing the patient to get her calmer at this crucial phase.

Soon, I gave a deep cut to the vagina with the episiotomy scissors during the final contraction and push, which then saw the whole head come right through. The contractions still strongly present, each shoulder in turn, and then the rest of the body, followed through; the baby wailing its protest in both my hands, almost immediately.

Handing the screaming new-born over to the midwife, I promtly repaired the wedge-shaped, neat vaginal cut, with 2-0 chromic sutures after locally anaesthetising with Xylocaine.

Feminine Power - It Fears Not The Cadaver

2010-09-16T13:13:00.001+02:00

I've uploaded a new an interesting account of a by-gone, first-time experience of mine that is truly memorable.

Read all about it in the Training Day page, above. It bears the same title as this post. Let's know what you think.

I'll be resuming duty 2 - 0-clock today, as soon as I dash down to the bank and back... The Pope just read his speech, following the Queen of England's, in his historic State visit to the UK. Interesting reference to the Holocaust, that he made.

Ordinary Out-patient Consultation Today

2010-09-06T21:59:00.001+02:00

Nothing exceptional has occured on the job today.

I'm a little worried though, of a booked Para one patient in second trimester, on admission for Pregnancy Induced Hypertention. Seems to be a bit of a difficult case, with her legs so enlarged with fluid and her complaints of sudden, poor sight in the right eye...

Gratitude Sermon

2010-09-05T19:27:00.002+02:00

I'm on a weekend break and the whole family went to Church - which doesn't happen often since my wife and I each run various shifts at our respective jobs. And, that I only recently committed my life to Jesus Christ - thanks once again, Lord. I'll be resuming duty tomorrow afternoon so I had better make the best use of my off-duty at home on Sunday.

The sermon was about Gratitude. Gratitude in our lives, for every single blessing in our existence. Never once forgetting that these great blessings come from the sole Benefactor - Almighty God.

Never forgetting also, that we are greatly blessed to have been given the greatest Blessing a human can receive - Jesus Christ Himself. Son of God as a Gift to each fallen human. The day a man or woman finally comes to terms with this great Truth, is the day that they become whole. Fully functional. Devoid of all defects hitherto present. We are all too aware of human defect, suffering and sickness.

The gentleman sitting in front of me typed-away on his Blackberry what his ears were picking, as the Pastor sermonised. I noticed the bold heading he had typed-in: "Gratitude Sermon".

I liked the sermon and enjoyed it within my spirit.

Newly-Wed With Lobar Pnuemonia

2010-09-04T20:56:00.001+02:00

She sat quietly but was obviously in discomfort as I raced down my notes of the admission. Clearly, it was a case of Right Lobar Pneumonia and you could see the effort she made with each painful inhalation.

There was reduced air-entry over the right lung-fields on auscultation. She was running a moderate fever and she coughed loudly in a dry, raspy manner. She was baby-faced, fair-complexioned and newly wedded. She had not missed her period recently and I pointed this out in my admission notes - she would require very effective antibiotics and I wouldn't prescribe any without ruling-out early pregnancy...

The child with the diarrhoeal disease who had had bouts of seizures, became quite well and was eventually discharged home. Her aunt, our Staff nurse, is on night duty with me tonight - one less worry on her busy mind, obviously.

Tendon Repair

2010-09-03T20:13:00.003+02:00

This pretty lady began to cry uncontrollably when I informed her that the very deep cut on the dorsum of her left foot, lateral side, was a little complicated - the tendon that dorsi-flexes the 5th toe was completely severed and would need a proper repair. She had been all too aware of her sudden inability to wiggle that toe, never mind the pain she was going through. It was an okada accident she had been involved in, and she soon began swearing that it would be her very last okada ride.

I gave her two options. One, we call in the specialist. The Orthopaedic surgeon. Or two, we the medical officers would handle it ourselves. And by "we" I meant I as the surgeon, with the staff nurse on duty as assistant. The former meant a greater financial cost. After quiet consideration and phone consultations with her acquaintances, she opted for the latter.

Off to theatre we went, upon which I soon began deftly uniting the ends of the severed tendon with silk 2-0 sutures, glad it wasn't difficult finding the distal end of the torn tendon - this sometimes would have run-up and out of sight immediately following the severance, that would then require an extended surgical incision on the skin and deeper tissues in search of it.

I had wisely put in a call to the ortho surgeon for a quick discussion, before theatre.

Deadly Diarrhoea

2010-09-02T13:11:00.000+02:00

A nursing staff of ours almost lost her 7-year old niece to Diarrhoeal Disease yesterday.

The child apparently had had many bouts of watery stools and was clearly, severely dehydrated and quite drowsy at the time of admission - loss of skin turgor, eyes sunken deep into the sockets, sunset gaze; the works.

And then she began to convulse. This posed a dilemma in terms of the dosage of sedative to administer in order to cancel the seizures - one cannot afford to administer too much a dosage so as not to further depress the Central Nervous System. Paraldehyde might have been best preferred due to its low depressive action on the CNS, but we had run out. I ordered i.m. Diazepam 15mg statim.

Clearly she had been electrolyte-imbalanced - in severe dehydration, serum electrolytes like sodium, potassium and so forth, are deranged in terms of their concentration in the blood serum. This clearly contributed to the convulsive seizures she suffered - she had several of them.

She gradually stabilized overnight, the administered fluid and electrolyte replacement infusions, greatly aiding her recovery.

Thanks also to the Paediatrician's input. She ordered Normal Saline, 20 mls/kg body weight, to be given. I had omitted Saline in my management plan, believing potassium to have been the main electrolyte variable since vomiting was minimal.

Recently Hernias, Now Pnuemonias

2010-08-29T13:53:00.000+02:00

I had a run of kiddies that had Inguinal Hernia repairs done recently - one of them, the two year old girl, didn't turn up on the 7th day post-op as appointed after her discharge on the 3rd day. Guess her parents had the wound-dressing finally removed elsewhere. She never did require the stitches removed - they were sub-cuticular and absorbable.

Now, I'm begining to have a run of Bronchopnuemonia cases in children - two admitted by me; a third admitted by our Paediatrician who runs a once weekly clinic with us. The poor kids just sit there breathless and unhappy-looking. Their parents usually look even worse with worry. They fair very well on i.v. antibiotics though, and are usually home by the fourth or fifth day.

Double-Dip Depression Looming

2010-08-26T21:55:00.000+02:00

I've been working, yeah. Haven't posted for a while though.

I really hope Europe and the US can eventually get their economic acts together, with the recent stories going round of a looming second recession by some experts. Depressing news indeed.

And talking about getting the economies of regions going, when oh when will gumpshun reign supreme amongst African governments in general, Nigerian in particular.

I removed the stitches of the 10-year old boy with Hernia, yesterday - the wound was far gone towards great healing. Wish I could say the same for our Nation

Surgery In A Two-Year Old

2010-08-20T19:53:00.000+02:00

I repaired a Hernia in this bubbly 2-year old female patient. Quite uncommonly seen in girls, it was a right-sided Inguinal Hernia and I was glad when, at the expected moment, the Hernial sac ballooned upwards and showed itself in full view of I, Dr Larry (who was assistant surgeon) and the Anaesthetist, who watched anxiously in the hope of a quick surgery so she could get back to her primary place of duty without further delay - the Operation had started a little later than scheduled for her liking, and finding the Hernial sac in some cases could take a lengthy bit of dissection.

The Hypoglycaemic Coma patient is still vegetating; too bad. If only he was brought in earlier.