Odysseys of George

As life cruises along; vita non est vivere sed valere

Browsing Posts published in November, 2006

Hi I forgot. The lady is well and is able to speak well with no loss of voice or tone and no chemical (calcium) imbalance. The pathology report however revealed a type of thyroid cancer growing within the left lobe. The type of cancer is called Papillary Cancer of the Thyroid Gland. My decision to remove the whole gland was definitely called for.
So what is this cancer?

Papillary Cancer of the Thyroid

    It is the commonest cancer of the thyroid making for more than 70% of cases.

    High cure rate with ten year survival rates for all patients with papillary thyroid cancer estimated at 80-90%.

    Peak onset ages 30 through 50

    Females more common than males by 3 to 1 ratio

    Spread to lymph nodes of the neck present in more than 50% of cases

    Distant spread (to lungs or bones) is very uncommon

    The etiology of papillary carcinoma is yet to be elucidated

    associations:
    1.Molecular – Activation of receptor tyrosine kinases (RET/PTC, TRK, MET)
    – A 10-fold increased risk of thyroid cancer in relatives of patients
    with thyroid cancer

    2. Iodine excess

    3. Radiation

1
Papillary cancer (low resolution). Notice the frond-like projections.

2
Psammoma body within a papillary cancer. Optically clear nuclei are circled in blue.

However, her treatment does not stop here. She would need serum thyroglobulin levels, body scan and if any remnant thyroid tissue is present, then she would require radioiodine ablation.

Reality and the supernatural.

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Many things occured over the last few days starting on Wednesday. Sorry for not writing!
It all began like something you would read on a story book. With this my blog will sound sombre!!

Life started almost as usual with me reaching work and doing my rounds. Then I get a call from a friend. It was about Rosma’s younger sister. Rosma started strong as she related the events to me. I remember she telling me about her sister during the raya holidays. As she spoke, her voice started to break and then she started sobbing so strongly that I was at loss of any form of consolation and she later, started speaking again. ” Dr. George, my sister is only 27 and is still unmarried. She just graduated.”

As the story goes, this young lady for no apparent reason started behaving aggresively. She never had any similar episodes before and there is no family history of any psychiatric disorders. Her change in character made her family take her to a hospital which immediately admitted her to a psychiatric unit. 3 days later, a smart psychiatrist questioned the events and felt that there was a definite clinical reason that was brewing. However, the younger brother being a university graduate was taken into supernatural causes and convinced the parents for discharge at own risk. Being sure that she “dirasuk”, they brought her to see a bomoh. During the period of treatment by the bomoh, they realised that she was progressively unable to walk and unable to control her ability to urinate. She was getting weaker but their confidence in the bomoh was overwhelming. 2 weeks later and 3 days prior to this admission, she started fitting. Initially it was a few times a day which progressed to a fit every 10 minutes. Rosma and her aunty was trying to convince the family especially the younger brother that she was getting worse and she needs medical attention. The brother refused and insisted that the bomoh told him that her fits were signs of removing the bad omen from the body. After much convincing and pleading the others in the family agreed to bring her to the hospital. She was diagnosed to have meningo-encephalitis, an infection to the brain matter, and was intubated and the family was told of her serious condition. When I reached the hospital to visit, she was in ICU and had collapsed twice needing CPR(cardiopulmonary resuscitation). All I could do was shake my head in pity as I knew she would not survive. Her kidneys shut down the following day and she passed away 4 hours ago.

It amazes me to see how strong the community’s believe in bomohs. In that two weeks as she deteriorated, they stood in confidence for the bomohs “healing” ability without questioning. Imagine if the doctors took that long, they or any other public in general would have made a lot of complaints. They did not even give the hospital any chance to investigate. And shockingly even the highly educated are guilty of such ignorant confidence. Better, it has also influenced the other races also.

To make things worse, is that she most likely would be alive if she had her treatment earlier and that makes me very sad and angry at the same time. I really feel depressed about her death.

I believe in prayers but I definitely do not believe in traditional healers. To make the public confused, the health ministry has condoned this traditional healers and has actually set up a centre for alternative medicine. How dumb? Then, it is not surprising, to attain votes they are willing to break all things fundamental. We, the doctor have gone against this but as usual it always fall on deaf ears. We even told them to rename the center to complimentary medicine as this treatment is in no way an alternative option. Rather then spending money on that, the health ministry can use that money to improve the patient care and doctors well known plight.

The truth, many waste time and money in being told that these bomohs can cure, and will only seek treatment when it is very late be it cancer or infection. Why?

About meningo-encephalitis:
http://www.patient.co.uk/showdoc/40000763/

Tell me what do you think this is about? The pictures says it all.

and even at rest,

Check out this link for the answer

Serpents and Snails

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Serpents according to Wikipedia has many meanings but to this article simply means the name given to a snake in a religious or mythological context. But rather than religious this is reality:

These are the famous moray eels. There are many variety about a 100 species but these are the ones I managed to see in my limited diving experience. These nocturnal (most active at night) fish have a long, muscular, snake-like body.Fierce but gentle, these sea serpents will attack if one decides to disturb its peace. Some are venomous. But again they make the winning shots usually due to its ferocity.

Then, we have the Snails or the sea slugs better known as Nudibranch. I wrote about it earlier . Just to share some more pictures.

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