Odysseys of George

It is out and this time it is hosted with the title of Diet & Food. Thanks, Dr John La Puma for including me.

This elderly man was referred to me for loss of weight, stridor(noisy, harsh breathing) for the last one year which worsened over the last 2 months.

This are his Xrays and CT scans

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From: Is this really necessary?

The early humans are claimed to have originated in East Africa. They survived on an inland diet based on land huntings but by 70,000 years ago their diet had changed to a coastal one, consisting largely of shellfish. Dramatic climate change at this period may have significantly reduced the Red Sea’s shellfish stocks and their exclusive appetite for seafood, caused them to leave Africa in search of new fishing grounds.

In order to fish in deeper waters, spears were replaced wih pieces of bone and were used as hooks and lengths of vine as line. The oldest known painting of an angler using a rod or staff comes from Egypt and history dates it from about 2000 BC. But little is known about the beginnings of shark fishing. However, this would require more sophisticated accessories with the need of larger boats, and larger angling devices.

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From My geriatric patient

The lady with breast cancer above came after 3 years not for the ulcer but because she felt giddy from her chronic blood loss.

The above two pictures belongs to an 84 year old lady who presented with large bowel obstruction. After questioning her, she says that she has been having symptoms for the last one year.

This a heel of an expatriate, who has been having it for a few years and insist that it is just an eczema of sorts!

A young lady with diabetes presenting with many episodes of carbuncle with poor sugar control, despite all the health education and nutritional advice,etc,etc.

A large sacral sore on an elderly lady — she is not immobile!

A healing ulcer of a lady in her 40s who kept her abdominal wall abscess for about a month. she is diabetic!

So, why do people wait till it is late? The lady with breast cancer left hers unattended for three years and the lady with colon cancer left her symptoms for a year. I find this an alarming situation especially when I have young girls with illness as common as diabetes despite all the education and support continue to indulge themselves in sweetness and come in with complications! it is also alarming when ladies refuse to examine their breast regularly and do PAP smears!

I find many men, avoiding treatment as they fear the procedures that are bound to take place. The women on the other hand, are either too embarrassed or afraid to come in terms with truth or refuse themselves of treatment afraid of nobody taking care of them. Ask around and you would be surprised to find many who have yet begin to do self breast examination or Pap smears. Though many are beginning to realise their responsibility in their healthcare, I still find many Malaysians leaving their health for others to care!

From “A 3 year ulcer”

As I walk into my ward for the morning rounds, I realise that my ward was half full and the atmosphere was unusually quiet. As I made a quick scan of the ward patients, my heart felt burdened as the images that were transmitted into the back of my retina were mainly of depressed looking geriatric females above the age of 70. ” Isn’t it always like that!” I responded within myself. Being in charge of the surgical female ward, the majority of my patients are of elderly females which I must say quite a challenge with their multiple medical issues.

The burden was not their age, but their length of stay and turbulent recovery. I must have been just tired as I seldom feel so. I must say I do get along quite well with elderly women and kids.

As I reached bed 17, it was another elderly lady. She look sad and depressed. “Somebody must have said something bad” I told myself. While listening to my intern rambling away the history, I reached out for her hand with a smile. She afforded a smile – half willing maybe out of respect for the profession. Without listening to my question, she asked, “Must I have the surgery?” I returned a gracious smile and examined her just to find this awful foul smelling lesion which she shyly acknowledges keeping it for 3 years.

This is not the first time I have seen something like this. Why do people keep ulcers for so long? Just recently another lady arrived to the ward with a large fungating ulcerated tumour which was so foul smelling that her office mates and my patients were complaining. After having handled all kinds of fluid of various smells, this almost made me vomit.

I was curious as this lady who spoke well, could not have been so ignorant! She wasn’t! She knew it was most likely cancer. This patient, was scared of surgery and the pain, and worried that nobody would take care of her, after all she was 70. She was adamant and against surgery. I was surprised as how easy my doctors gave in to her — was it her age? After having lengthy sessions with her, and with strict instructed guidance to my doctors on handling her case with love and thoughtfullness, we manage to ease her fears and she agreed for surgery after being with us for a week. That gave us enough time to investigate and stage her! However, I feel the reason she agreed was because for once in her life she saw her children coming together despite their busy schedule, to encourage and support her! Not the talk but the act of togetherness and concerted effort has great influence on an elderly patient.

I am happy we managed to talk her into doing the surgery. Now, she appears much more healthy and cheerful. Now she is doing her part in health promotion talking to my other patients, encouraging my other geriatric patients to ambulate and eat! A wonderful lady! Across her, is another 80 year lady who presented with a bleeding gastric ulcer and another 84 year old who underwent emergency surgery for an obstructed large bowel secondary to colon cancer,who refuses to eat or move and insist that she should have been given some lethat injection. Upon further questioning, I realised that she has 4 children and the only one who takes care of her has severe backache and is often in tears and barely can take care of herself! thus, this patient of mine feels herself to be a burden to her family.

As I sat to ponder another issue came up — why the delay?

TOP 20 ENDANGERED SHARK SPECIES OF THE WORLD

Data compiled from the 2000 IUCN Red List of Threatened Species and FishBase.org

Endangered Shark Species
1. Ganges shark — Critically endangered (IUCN)
2. Borneo shark — Endangered
3. Basking shark – North Pacific & Northeast Atlantic sub-populations — Vulnerable

4. Speartooth shark — Endangered
5. Whitefin Topeshark — Endangered
6. Angular Angel shark – Brazilian sub-population —- Vulnerable
7. Smoothback Angel shark — Endangered

8. Spinner shark – Northwest Atlantic sub-population — Near Threatened
9. Pondicherry shark — Critically endangered
10. Smoothtooth Blacktip — Vulnerable
11. Blacktip shark – Northwest Atlantic sub-population — Vulnerable

## Not to be confused with blacktip reef shark.

12. Dusky shark – Northwest Atlantic & Gulf of Mexico sub-populations — Near Threatened

13. Grey Nurse shark (aka Sand Tiger) — Vulnerable

14. Great White shark — Vulnerable
15. Gulper shark
16. Basking shark
17. School shark (aka Tope shark)
18. Bluegray Carpetshark
19. Porbeagle shark
20. Whale shark

Insufficient Data
(The sharks listed below have not had enough data collected about them to determine whether or not they are endangered.)
1. Thresher shark (Alopias vulpinus)
2. Java shark (aka Pigeye) (Carcharhinus amboinensis)
3. Kitefin shark (Dalatias licha)
4. Salmon shark (Lamna ditropis)
5. Megamouth shark (Megachasma pelagios)
6. Broadnose Sevengill shark (Notorynchus cepedianus)
7. Bigeye Sand Tiger (Odontaspis noronhai)
8. Narrowmouth Catshark (Schroederichthys bivius)
9. Great Hammerhead (Sphyrna mokarran)
10. Argentine Angel shark (Squatina argentina)