Odysseys of George

A 65 year old lady presented with an painful swelling over the umblicus which was progressively worsening. This was associated with more frequent episodes of vomiting and the inability to open her bowel and pass wind. Her abdomen was progressively inceaasing in size and this percipitated her already failing heart and poorly controlled diabetes causing her to be breathless and even more swollen. She was also morbidly obese. She was definitely not one of the best of patients but surgery is definitely indicated – earlier the better for her with such poor background history.
The diagnosis : Intestinal Obstructon from incarcerated / strangulated paraumbilical hernia.

It looks small but remember she is big.

This is the hernial sac which had an a short segment of the transverse colon stuck within the sac together with some omentum.

Sorry about picture quality – did not realise my batteries were dying.

The end result,

She got better and have started eating on day 2 after surgery. Yesterday night 4 days after surgery, I visited her to wish her Selamat Hari Raya before the long break and cought her munching away on some butter bun secretly while lying on her tummy as not to be seen by the nurses — no wonder her blood sugars does not seem to be coming down. And obviously her heart failure has subsided making her feel much better. Then again, some habits are hard to die and some lessons in life are too painful to learn.

I love to write in parts – makes me feel I am writing a story!

A hernia is a protrusion of an organ through a weak defect of the layer or tissue that covers it. Many types of hernia, the commonest being the inguinal hernias. My favourite however are what we call as the ventral hernias. These are protrusion of an organ within the abdomen through the anterior (ventral) abdominal wall . Examples:

Well, these are the commoner forms of ventral hernias — incisional (top 2 photos) and paraumblical hernias. Incisional hernias as the name states are hernias through the weak scar tissue from previous surgery.However, the defect or better known as the hernial neck, is usually broad and therefore seldom gives rise to strangulation. The paraumblical hernia however,occurs through a defect close to the umblicus and therefore the neck is narrow and the risk of strangulation is higher.

Surgery, whether laparoscopic or open is the only option in reducing the hernia and repairing the defect.

Open repair of the third photo

Laparoscopic repair of the first photo

Hernias left alone can lead to certain complications such as irreducible hernias, strangulated hernias and obstruction to the intestines.That brings me to part 2.

My sister sent me this. Thought of sharing with the community.

A terminally ill young girl in a New York Hospital wrote this. Ponder on!

SLOW DANCE

Have you ever watched kids on a merry-go-round?
Or listened to the rain slapping on the ground?
Ever followed a butterfly’s erratic flight?
Or gazed at the sun into the fading night?

You better slow down.
Don’t dance so fast.
Time is short.
The music won’t last.

Do you run through each day
On the fly?
When you ask How are you?
Do you hear the reply?

When the day is done!
Do you lie in your bed
With the next hundred chores
Running through your head?

You’d better slow down
Don’t dance so fast.
Time is short.
The music won’t last.

Ever told your child,
We’ll do it tomorrow?
And in your haste,
Not see his sorrow?

Ever lost touch,
Let a good friendship die
Cause you never had time
To call and say “Hi”

You’d better slow down.
Don’t dance so fast.
Time is short.
The music won’t last.

When you run so fast to get somewhere
You miss half the fun of getting there.
When you worry and hurry through your day,
It is like an unopened gift….
Thrown away.

Life is not a race.
Do take it slower
Hear the music
Before the song is over.

Just before I joined the Masters of Surgery programme in UM, I was sent to a small town, I never heard off in my life … Chenderong Balai. This is a small town, located about 40minutes from Teluk Intan and one a half hours south of Ipoh. I was the young boss of Klinik Kesihatan Chenderong Balai(KKCB). This clinic never had a doctor for the last 9 years before I came. One of the first staff I met was my ambulance driver, En. Jaafar. He was also my personal driver and thus over the two years with the staffs of KKCB, we became very close friends. A very supportive staff with dedication to the service and also very friendly.

Yesterday, I receive a call from another staff, informing me that Jaafar was taken ill. He had recently lost 30kg, and presented himself to the Teluk Intan Hospital with yellow discoloration of the sclera. He was diagnosed as having advanced cancer with involvement of the liver. The surgeons in Ipoh, will be operating on him in November and to commence chemotheraphy thereafter.

I am very sad to hear this. In a town, where I was the only non-Malay, he and the other staff made me feel at home. The memories are still very vivid. He gave me every ounce of support he could to me and always tried to make me feel happy.

next : My dear driver,En Jaafar and a silent killer

thereafter: My dying driver

Many do not know this, but I once used to play the violin. I started early but did not have good teachers during the early years in Alor Setar. So it was an on-off kind of thingy till my parents were told of this superb teacher from Penang Philharmonic who comes to Alor Setar to teach. Thus , by then I was in secondary school and really into it. However, it had to stop when I was in Form 5 because the training requires a great plenty of time for practice. I was in Grade 5. I still love the violin and hope to complete it one day though my fingers are getting a little to stiff at the phalanges.

The violin, bowed string instrument with four strings tuned in perfect fifths. It is the smallest and highest-pitched member of the violin family of string instruments, which also includes the viola and cello. A person who plays violin is called a violinist or fiddler, and a person who makes or repairs them is called a luthier, or simply a violin maker.

The violin was born in northern Italy in the early 16th century. The oldest documented violin to have four strings, like the modern violin, was constructed in 1555 by Andrea Amati.

The most famous luthiers, between the late 16th century and the 18th century included:

* Amati family of Italian violin makers, Andrea Amati (1500-1577), Antonio Amati (1540-1607), Hieronymus Amati I (1561-1630), Nicolo Amati (1596-1684), Hieronymus Amati II (1649-1740)
* Guarneri family of Italian violin makers, Andrea Guarneri (1626-1698), Pietro of Mantua (1655-1720), Giuseppe Guarneri (Joseph filius Andreae) (1666-1739), Pietro Guarneri (of Venice) (1695-1762), and Giuseppe (del Gesu) (1698-1744)
* Antonio Stradivari (1644-1737) of Cremona
* Jacob Stainer (1617-1683) of Absam in Tyrol

The arched shape, the thickness of the wood, and its physical qualities govern the sound of a violin.

I love the violin!!

This is to all my friends who celebrates Hari Raya.

Maaf Zahir Batin