thankful

So many things have happened this month, like my san juan experience, christmas, my cousins stay at my house, and so much more.  I wanted to post so many pictures in my blog, but there are just so many that I don’t know where to start!  I want to rest so much so I guess talking through typing is the best I can do for now.  If you wanna see my pictures so badly, just view my friendster profile.

The worst but most important thing that happened to me this break was my visit to the dentist.  I have and I think I always will hate getting my teeth cleaned and worse than that, I absolutely hated getting my impacted tooth pulled out.  I was going to wait until the summer break to have it extracted, but I told myself that it better be done now while I can get a lot of bedrest.  I don’t want this tooth to get in the way of my work or summer vacation any longer.  So I sat in that chair, finally getting to experience having anesthesia injected into my gums.  It was a weird experience.  It must be the feeling people get when they have a stroke or when they acquire Bell’s Palsy.  The left half of my face went thick and numb.  But trust me, the pain hardly disappeared!  You see, my tooth isn’t just impacted, the 3rd molar on the lower left side of my mouth grew lying horizontally, and was buried under bone!  So they had to get some bone out and incise some of my gum just to get the tooth out.  It took an hour to complete the procedure, but it took more than a day to make the pain bearable.  I ended up crying while I was still on the chair, but I couldn’t help myself, it was really really painful…  As of now, I still can’t eat well.  My throat was so worked up that it ended up sore.  I hate the feeling of having sutures in my mouth.  I can’t wait till the dentist removes it.

My break time is nearly over… 3 more days and I am back in San Juan, back to community medicine, back to being a PGH intern.  To be honest, I haven’t started studying for OB like I promised, and I haven’t started tallying the data for our community project.  I haven’t even submitted my reaction paper for my teacher, Dr. Cordero.  If the pain in my mouth goes away by tomorrow, I will probably  start working.

There are so many things to be thankful for this year… 2007 is the year I became a doctor.  It is the year when I became a UP intern.  I realized that I have so many friends around me, and surprisingly, I am still in touch with my friends from high school, college, and medical school.  My family, although is not living in one roof, is filled with love.  My cousins have truly grown up and are bravely facing their future more bravely than I ever did, which makes me twice as proud.

But of course, my heart is not as full of love as I want it to be… There is that one room which contains one chair that I sit in once in a while.  Although it is a good place to reflect, I remember that this room in my heart also was filled with good things.  I guess for now it shall stay empty, and reserved.

Will I have the same luck when 2008 comes?  I just realized that next year is my year according to the Chinese calendar.  It’s the year of the rat… Hehe, before I was ashamed that I had to have the rat as my animal, it just doesn’t seem as glorious as the other animals were.  But knowing now that next year I will be faced with my internship graduation, and I will soon be taking the board exams, I guess I am lucky that this will all happen during my year.

Before I end my blog entry for this year, I would like to thank my family for all of their support.  I know I don’t study as diligently as others do, but trust me that success is in my mind, especially because all my achievements are all thanks to you.  To my relatives, especially to my cousins who have made vacations oh so worth it all, thank you for reminding me that life is not all just work.  To my friends, thank you for accompanying at all days, because without you, I would not learn so much and I would have done so little.  And thanks to my patients, residents, superiors, juniors… ^_^

classic case

Patient for discussion today is:

General Data: RD, a 30 year old, male, single, Roman Catholic, Filipino, currently residing in Metro Manila.

Chief Complaint: rashes

Profile: Patient is a non-diabetic.  Known to have Prehypertension (According to JNC VII).  He is a heavy smoker, and is an occasional alcoholic beverage drinker.

History of Present Illness:

The patient was apparently well until 8 days prior to consult, when he experienced low grade undocumented intermittent fever (Temperature undetermined).  This was accompanied by low appetite and generalized body malaise, with no diarrhea, no vomiting, no headaches or abdominal pain.  Patient sought consult with a relative who is a doctor, and was advised to increase oral fluid intake and to take Paracetamol 500 mg/tab 1 tablet q 4 for Temp greater than or equal to 37.8.  Patient’s fever lysed 3 days prior to consult.  It was also during this time when erythematous pruritic rashes started to appear all over his body.  No medications were taken.  No bleeding episodes such as melena, hematemesis, hematochezia occurred.

On the day of consult, Tourniquet test was done, which revealed a positive result.

Review of Systems:

General: (-) unexplained weight loss/gain  (+) generalized weakness (+) anorexia

Skin: (+) rashes (-) jaundice (-) pallor (+) pruritus  (-)ecchymosis (-) hematoma

Head and Neck: (-) masses (-) lymphadenopathy (-) headache (-) nape pain

Eyes: (-) icteric sclerae (-) blurring of vision (-) eye pain

Ears: (-) decreased hearing (-) ear pain (-) discharge

Chest and Lungs: (-) dyspnea (-) cough (-) colds

CVS: (-) palpitations (-) orthopnea (-) orthostatic hypotension

Abdomen: (-) abdominal pain (-) vomiting (-) nausea (-) diarrhea (-) melena/hematochezia (-) hematemesis

Extremities: (-) weakness (-) edema

Past Medical History:

Patient has not had a similar illness before.  Patient has not had previous surgeries or hospitalizations.

(-) DM, HPN, Ca, Asthma

Personal and Social History:

(+) smoker

(+) alcoholic beverage drinker

Patient previously worked as a call center agent.

Diet is high in salt and fat.  Lives in a crowded community with note of stagnant water in the surroundings.

Physical Examination

Vital Signs: BP 130/90 HR 90 RR 23 T afebrile

GS: awake, conscious, coherent, oriented to time, place and person,  not in cardiorespiratory distress

SHEENT: warm, good turgor, anicteric sclerae, pink palpebral conjunctivae, (-) lymphadenopathy, no neck vein engorgement, no tonsillopharyngeal congestion, (+) HERMAN’S RASH
C/L: symmetric chest expansion, no retractions, clear breath sounds

CVS: adynamic precordium, normal rate, regular rhythm, no cardiomegaly

Abd: soft, flabby, normoactive bowel sounds, nontender

Ext: full and equal peripheral pulses,  no cyanosis, no edema

 ASSESSMENT:

Dengue Hemorrhagic Fever Grade I

CASE DISCUSSION:

This is a classic case of DHF I.  It presented us with 5 day history of fever, with anorexia, followed by the appearance of Herman’s rash, a pruritic (itchy) red rash that spreads all over the body.  A positive Tourniquet test strengthened my diagnosis.  I did not do a CBC with platelet count anymore, since the patient is already 3 days without fever, and I am expecting the disease to be over soon.  We would only classify the disease as Grade 2 if there are other signs of hemorrhage, such as melena or hematochezia (bloody stools) or hematemesis (bloody vomit) or gum bleeding or nose bleeding.

PLAN:

I educated the patient on the course of the disease.  I told him to watch out for any signs of bleeding and abdominal pain (which could indicate internal bleeding) and further increase in weakness.  I told him to keep eating, but to avoid dark colored foods so that we could easily determine if bleeding has occured.  I gave him anti-pruritic medication for his rashes.  If bleeding would occur, I advised him to get a CBC with platelet count done and to see me or my dad for us to determine if he needs to be confined in the hospital for fluids management.

The End.

P.S.  Get well soon, kuya Ryan ^_^ 

Iryu: Team Medical Dragon

Part of being a blogger is promoting the things that are important to you. That’s the reason for posting this blog today. I recently finished watching Season 1 of Iryu: Team Medical Dragon, a Japanese live action drama that revolves around the life of Dr. Asada Ryutaro. He is a highly skilled surgeon who specializes in emergency, trauma, and TCVS type cases. He has worked in NGO camps and is able to handle the pressures of senior professors of university hospitals (by simply not caring what they think at all). Together with his multi-talented Team Dragon, he is able to accomplish even the most difficult operations. It was a perfect hospital-based drama for me. I could even say that it is better than all the other hospital-based shows I have seen. It used the Japanese type of energy that they use it battle scenes in showing procedures or operations that otherwise would have looked entirely boring to the average person. A surgeon was portrayed like a hero in an anime (the show was based on a manga after all) with skills (like a fighter) that only he can attain. There is an anesthesiologist who acts like his partner, boosting his powers to the maximum level. There is even an intern (who has good looks by the way) that acts like his protege, learning from his every step. The energy level I sense in that drama made me stick to it more and more after each episode! A future surgeon like me wants to be like the ideal Asada Ryutaro. ^_^ I even made my friend Dave (Hi Dave!) Watch it with me, and even he had a difficult time stopping the video ^_^

I thank my cousins Cielo and Tikoy for introducing me to this series. They have no idea how much I loved this series ^_^ To my delight, there is even a season 2! Tikoy, now you realize how important you are to me, because I regard you as my dependable anesthesiologist ^_^ ? ne? Cielo, you ready to become a great doctor? ^_^ Don’t worry you can do it! It’s in our blood after all… ^_^

hataw! hanep! hero!

I am an anime fan. An otaku, if you have to be so picky about it. And to honor our tradition, Tikoy and I, together with our friends, went to the SM X Convention Center beside Mall of Asia to witness the first day of Hataw! Hanep! Hero! 3, an anime and gaming convention sponsored by Hero Channel. Before going there, we had a heavy lunch at KFC, because as veterans, we know even a hotdog on a stick at that place would cost a fortune (50 pesos! Geez…).

So we went there by taxi… Opening starts supposedly by 10 AM, and we arrived there past 12, and to our surprise, there is still this long line!

But we get in, eventually… It wasn’t a hot day, so we were comfortable waiting in line… gawking at the cosplayers, and thinking of what it would look like inside…

Well, the place turned out to be just as I expected it to be… There was a grand stage, which had a band set at the side… There was a quiz bee going on when we came in… A few booths were selling anime goodies and a couple of computers and arcade games were set up to promote some online games that are also sponsors of the events.

We take a few more round trips at the convention center until our friends arrive. Riot, an old friend that I met at a convention as well, Olga, the best (if not the only) Cavite Boy I know, and my new friend Fei (The guy dressed up as SubZero), all came and joined in on the fun. Trust me, it’s more fun to go to these events with a set of friends.

I wish I could have stayed longer at the event, but I wanted to meet my dad at Rockwell…

But before leaving I was able to accomplish the things I wanted to do. One is to buy a plush doll of Gaara (although I originally planned to buy a plushie of Ryuk) and to take a picture with the cosplayers of the captains of Soul Society (Bleach).

Maybe one day I will finally be able to join the singing contest… and win!  Till next year!