Odysseys of George

48 year old lady presented with bilateral breast lump. On examination, vague breast lump at upper outer quadrant of both breast. Negative risk for malignancy. Had a procedure done in a beauty parlour 25 years ago.

Any guesses?

The elderly lady above demonstrates a case I saw in my clinic recently, but my patient was way younger in her early 30s. She developed this weakness over the left side of the face which was rather sudden in onset 3 days prior. She was otherwise very well and there was no history of trauma, infection or ear symptoms. There was neither any headaches nor any weakness associated to the upper limbs and lower limbs. She was otherwise well.

She had all the findings as the picture above, actually exactly like the elderly lady above. So what was wrong?

Well, this condition occurs when the nerve which is responsible for the control of facial muscles becomes swollen or inflammed causing the muscles to paralyse or weaken. It is usually abrupt with no apparent cause. This syndrome was first described in 1821, by the Scottish anatomist and surgeon Sir Charles Bell. From then, this condition was called Bell’s palsy. It is an interesting disease but a scary phenomenon for patients.

The nerve involved is called the facial nerve. The path of the facial nerve is complex; this may be the reason the nerve is vulnerable to injury. Two portions of the facial nerve leave the brain at the cerebellopontine angle, traverse the posterior cranial fossa, dive into the internal acoustic meatus, pass through the facial canal in the temporal bone, then angle sharply backwards, where they pass behind the middle ear and exit the cranium at the stylomastoid foramen. From here, the facial nerve bisects the parotid gland, and then terminal branches extend from the parotid plexus to innervate the muscles of facial expression.

Though the cause is still yet unknown, many believe that majority of them are due to viruses. The most common being the herpes simplex virus, which also causes cold sores and genital herpes. Other viruses that have been linked to Bell’s palsy include the herpes zoster (chickenpox and shingles) and Epstein Barr (infectious mononucleosis).

Bell’s palsy occurs more often in people who:

* Are pregnant, especially during the third trimester, or who are in the first week after giving birth
* Have diabetes
* Have an upper respiratory infection, such as the flu or a cold

Like my patient, there is also a genetic predisposition where most of them have recurrent attacks of Bell’s palsy but this is rare.

For most people, Bell’s palsy symptoms improve within a few weeks, with complete recovery in three to six months. About 10 percent will experience a recurrence of Bell’s palsy, sometimes on the other side of the face. A small number of people continue to have some Bell’s palsy signs and symptoms for life.

Eye care, steroids, pain control and reassurance are the main essence in the treatment of Bell’s palsy.

Well it has been some time since I have written anything medical based. So, I was thinking and realized that for something so common this particular problem is so little discussed with public. Then again, I guess the reason being that despite knowing much about it, we still find this a difficult issue to treat.

So what is Dyspepsia? continue reading…

I came across this while surfing through MMR blogpost. Even before reading it, I had sensed that this would be something that would move me.

As I read the first paragraph of the post, I immediately realized that this was something long due and very appropriate – A tribute to the late Tan Sri T.J.Danaraj, the founder of the medical faculty University Malaya. A visionary man who had managed to have an impact on me even though he never thought me.

We stand on the shoulders of Giants is a teaching blog dedicated to the late Emeritus Professor T J Danaraj, the foundation Dean of the University of Malaya Medical Centre. The blog is moderated by Dr. Wong Yin Onn.

I remember presenting about this great man, during my batch Deepavali Festival as a tribute to him. We felt that little was done to honour this man, so much so that many present UMMC medical students hardly even know him.

I end this with a letter he once wrote which I copied from that very blog. An encouraging note to all……….

Dear …….,

T.J. Danaraj

TJ Danaraj

A young and thin paraplegic lady was brought into ED for severe abdominal colics and constipation for more than 3 weeks duration. The unsuspecting medical officer decided to do an abdominal Xray.

From Radiology Quiz

This is an easy guess.

Her family was surprised with the finding which she finally admitted to know about. She was given some medications and was send home. Never make assumptions!

A 14 year old boy, presented with sudden episode of bleeding per anus. Both OGDS and colonoscopy was negative and the bleeding persisted. He was then referred to us for an angiogram.

Any idea?

.. continue reading…