Anaesthetist vs. Pathologist

 

Today an Anaesthetist came to review one of my patients. I have to say, she was so hot! When I look back, I can remember so many Surgeons pairing up with Anaesthetists. It may be due to the mere fact that there is more chance of meeting between these two specialties.

Once my senior resident told me. “It’s better for a Surgeon to stay away from an Anaesthetist. Because if a patient sucks up on theatre table, you can blame on Anaesthetist. But if you marry a Pathologist, she will always cover for your resection specimens. Secondly the nonclinical doctor will have more free time for you.”

Patient c/o Nonsignificant symptoms.....

      As a general practioner you will always come across patients complaining of nonfocal pain in abdomen, limbs, whole body, complaints of gas and related gaseous problems, burning sensation in every possible surfaces and orifices in body, lack of well being, decreased apetite, an array of urinary complaints and toilet complaints.
      We will do a clinical examination, which wont dig out anything in 99 percent of these cases. Then we go to our array of lab and imaging investigations. This may reveal some unrelated hidden pathology in its early stages ; like a fatty liver or prostatomegaly or a small fibroid or a mild splenomegaly ( even called scanomegaly) and blood reports will follow the bell shaped curve of normal distribution. Marginal reports will end up in repeating the test to confirm whether its normal.
     Multiple urine cultures, sputum microscopies, chest xrays, ECGs, CT scans, USG s by different radiologists- all being reported in various levels of normalcy.
    Sometimes the GP has to pin up the cough to a small umbilical hernia or dysuria to mild splenomegaly or hiccups to fibroid, so that the patient could be distracted and  directed to some specialist. Now a days Gastroenterologists doesnot wait for the Psychiatrist to start for antidepressants when they find no reason for the bloating and dyspepsia after required tests and PPI trials. Good thing is that so many of this symptoms get relieved too.
   But it actually takes little experience with patients to divide their complaints to significant and non significant. I think its always better to leave the decision to an expert in the field of suspected disease. Expert doesnot necessarily mean a doctor with degree, but one who sees a lot a such cases.
    My professor always tell, never ignore a complaint made by a patient. Its unlikely that any person in normal mind will complaint of a pain anywhere in body, unless there is a clear advantage of malingering. Everybody wants to be in goodhealth. But somany times we cannot explain the cause of these symptoms or to be exact, find a  treatable cause. Many of them are attributed to neuropathy. Naturally it should be, because most of these sensations are transmitted by nerves only.
   I had many instances like that. Instances when  I could not comeup with a diagnosis which explains the symptoms or treatment that could alleviate the symptoms even after an array of checkups, logical thinking and lab tests. Then I tell the patients " I am sorry that I am not able to find a specific reason for your symptoms. But I can assure you that, you dont have any serious illness that you should be worried of. So take these medicines ( probably painkiller or vitamin placebo) and hope rest of it will subside of its own ( which means you have to live with it....and now getoff my clinic !!)" Majority are happy to hear that, but those with that 'psychiatric face' or with peculiar personalities will be  unhappy.

Angelina Lignocaine II

 Well as you may not know, that Angelina is my laptop and she belongs to the Lignocaine family of my gadgets. Now you can infer that I got a new laptop, since my old one got comatosed. At first when it didn't wake up, I thought it would be a minor thing. But the doctor says something serious has happened and it will need a motherboard transplantation. I did my calculations and decided to buy a new 12 inch which cost a few bugs more than the price of a new mother board. Since the old one is not in service this white colored cutie is given the same name. The other guys are Smith L- the hard drive, John L- the smart phone and Black Jo- the motor bike.

The culprit of worst pain

        In my knowledge and short practice in Emergency medicine and OP management, the worst pain is seen in patients suffering from neuropathies, to be exact- pain of neuropathic origin. It may be due to a nerve entrapment or nerve root compression due to fibrosis or cancer metastasis or a local invasion of tumor.
   What made me give a thought about it today, is a patient who came last night. In contrary to the usual row of ureteric colic patients who come in midnight and early morning, about five patients came with various limb pains last night. Two of them had history of LBA with acute exacerbation of pain radiating to legs, another with history of peripheral vascular disease, another with arthritic pain and one girl with right arm pain.
  The girl had a history of right shoulder injury three months back , now complained of radiating pain to arm. She is already under the followup of Neurosurgery and they have detected some mild compression around cervical nerve roots in MRI. She had already received a shot of Diclofenac before she came in. She was on oral Pregabalin and Tramadol-acetaminophen. She was crying out in severe pain. The family members were trying to console her. I had to give her Tramadol followed by two doses of morphine and Phenergan along with oral Gabapentin with 45 min to 60 min interval between each. I am not sure whether its due to drug's effect or exhaustion of crying for continuous 6 hours, she finally fell asleep. Needless to say then I began to worry whether these opioids are going to cause any over sedation, so I kept  watch on her for some time. She was only lightly sedated. So I could finally sent her home with an oral prescription.
         Definitely in a ER, you will come across so many types of pain, and a pain which is not resolved by the first and second stage analgesics is going to be a pain in your neck.

PS: Whenever I hear the term neuropathic pain, the picture that comes to my mind is the grimacing face of House MD.

Chocolate , Cheese , Bacon and Red wine

Although the above mentioned items are not part of our cultural diet, these things are attached with a good feeling. I am going home for two weeks in may. All good food and Moms love..counting days ..

The Emergency Days..

      Now I am posted in the Emergency Department, a place I usually don't like. But this time I am feeling different. Because the Senior Resident I am working with, is a very good person. He likes to keep his kingdom clear and so he has the habit of disposing patients as early as possible. At the same time one or two needy patients get admitted too. This fact may amuse you, But the hospital I work is a tertiary referral center and research center. So it is protected by Law to prevent overcrowding like any other public sector hospital in the country. Also we have got a multi-specialty hospital on the other side of road run by the government, so that the rest of the needy patients are referred there.

I am not proud of having a really fast Emergency hand, actually its too clumsy. I will take long time for me to think and take decision before an intubation and the black art of acid base/ electrolyte imbalance still remains a puzzle. I pray to Lord ' Kindly alleviate the pain and suffering of the persons who come to me with an ailment'

The Watermelon days and Running life

    Life is happy. Started running on April 1st. Till now I have gone thrice for running in the morning. I forgot to mention I got a pair of dedicated running shoes- Adidas Marathon 10.5. Unlike my gym shoes I got this directly from showroom. I had to shell out 7 grants. But I hope this is gonna work. Definitely the weight loss and cardio exercises at gym has increased my capacity to run, but still it is in its infancy. I will have to work hard to get it right. Dieting is also going on. I will have to decrease 6 more kilos to reach my goal. Anyway I am at my lowest weight now,which I can remember from last 7 years.

My weight loss chart

As you can see I started with 86.6 and there is a sharp drop in the first two days which is explained by dehydration on starting a new exercise or diet program. After that it is more of a steady fall. I had kept my calorie intakes to around 500 kcal and lots of water, mostly from fruits I ate ( orange, watermelon, cucumber). Since the days of orange is over I think I should call it Water melon days..:)

Old school friend and study tour

This is another happy incident that happened in the end of March, my old friend from school came to visit me. He was so adamant that he wanted to see Taj Mahal. So for the second time I had to ride overnight to Agra. The ride in the night and early morning is also unforgettable as the Venus star moved from one horizon to  other across the clear sky as a sign of rising sun. Although we were cruising through the Express way which is unidirectional and needed no additional pointer for direction, watching the guide in the sky 'the Hunter' in the midnight was thrilling. The cold drift chilled us to the bone, and we were afraid we will get frozen before we reached there. But all the tiredness of the sleepless ride vanished by the sight of the world wonder illuminated by the sharp yellow streaks of light from the rising sun. The marble tower imbibed all the colors and turned into a golden hue. The return journey in the scorching heat at noon was again eccentrically wonderful. We had to stop every 50 km to take rest. In the midway we slept for half an hour in front of a closed shop. By Gods blessing we reached Delhi safely.

Little modelling around Akbar the Great's Redfort

The typical Taj pose- proud to be Indian :)