Breathe in...Breathe out...

A "Manananggal" with no wings...

2009-02-23T07:18:00.000-08:00

DON’T DRINK AND DRIVE !
Especially on your Birthday...

A very unfortunate incident happened on this man’s birthday. This was my patient who apparently had a drinking spree with some of his friends. On that same night he decided to ride a motorcycle to fetch a friend. With too much alcohol running through his veins he thread a dark street not knowing misfortune will befall him. Because of alcohol toxicity, he didn’t saw a trailer motor vehicle in front of him. He hit the back of the trailer with a piece of steel pipe, protruding from the vehicle. The pipe pierced through his abdomen down to the peritoneum, slashing slitting almost half of his abdomen, spilling his guts on the concrete pavement. Several bystanders helped him, gathering up his bowels, he was brought in the hospital. I’ve seen the patient and was referred to our surgeon, he was scheduled for Emergency Laparotomy, blood transfusions were done. He survived the operation but pass away after 2 days. He succumbed to severe infection. Drinking and Driving surely is irreconcilable.

Case 2 Chicken Baby

2008-06-09T18:38:00.000-07:00

One morning, while making my daily rounds at the hospital where I worked. I was at the Pediatrics Ward when the Midwife informed me that I got a call from the DR (Delivery Room), It seems that the Resident on Duty needed some help with something. Also she said that I needed to rushed, for the patient who was on labor had some problem. I ran passing the NICU (Neonatal Intensive Care Unit), not bothering to change in to scrubs. I as I pushed through the swinging doors of the Sterile Area, I heard my colleague shouting to call me. As entered the DR I saw her face in terror, apparently the patient who was in labor, who was just have been admitted, delivered a baby footling breech (the baby's feet came out first), and when the doctor on duty did't see any head, she thought that it was left inside the mother's uterus, that is why I had a call, because she thought that we have to prepare and refer for an Emergency Ceasarean Section. I saw the lifeless baby in the bassinet, I examined the stump which looked like a neck and found some hair growing from it. I told the Doctor that there is no need to refer the patient because there is no head left inside the mother, the head just didn't develop at all. Looking at the baby it reminded me of the dressed Magnolia Chicken, I guessed we woudn't be eating chicken adobo for awhile. Taking the history of the mother it seems that it was her seventh child already she had a Diarrhea during the first month of her Pregnancy, she didn't took any multivitamins nor prenatal check-up in our Hospital. She even had a huge tummy filled with amniotic fluid which she didn't bother to have a consult. Apparently she was into active labor that night, the bag of water ruptured and gallons of amniotic fluid gushed out. She was being attended to by a traditional "Hilot" and when she wasn't able to deliver the baby she was rushed to our institution.

During my student years I have seen cases of Anecepahaly, this is the conditon in the Central Nervous System where there is failure of the development of the brain or parts of the brain like, cerebrum, cerebellum or the cranial vault. But this was the first time I saw a total non-developed head, not even in my medicine books did I saw such condition. The cause of this defect is unknown but is correlated by not taking Folic Acid supplement. The addition of folic acid to women in child-bearing age seems to lower the incidence. So to all women out there if you are planning of getting pregnant load up with Folic Acid, or simply include green peas, chickpeas, asparagus, brocolli, orange, papaya and ummm...strawberries in your diet. You don't want to have err...a Chicken Baby...tikti-laok!

Case1 Freaky

2008-06-09T02:54:00.000-07:00

Well for my first out of the ordinary case in my practice, have you seen the movie "Hell Boy"? It was the first thing that came to my mind when I saw this infant although this baby was a female. I honestly believe that all children are a blessing. But due to some unexplainable circumstances deformities may give you goosebumps every now and then. Two years ago we have this pregnant patient who complained of not going into labor even though it was past her due date which is already a month ago! In medical field we call this postmaturity wherein the baby has past the 42 weeks of gestation. As I have said before mostly our patients belongs to the low socio-economic group, most of the times pre-natal check-ups were not done. So this patient came in with no history of check-up, no vitamins, much more no Ultrasound. With her complaint was she can't feel her baby moving at all. After doing the examination to her, we can't appreciate any fetal heart beat nor movement. And computing the weeks she has been pregnant for the sum of 46weeks! she has been pregnant for 11 months already! At that time we still have an Obstetrician so we referred the patient to him. We have an outdated Ultrasound Machine which we used for knowing the presentation of the baby in the womb and detecting heartbeat and movement of the fetus. But the results wouldn't be official since we were not trained to do so. If the patient can't afford a private sonologist we are like walking in the dark, expect the unexpected. So the decision of the OB was to induce labor, since the patient has no fever, no bleeding, we still have time to wait hoping for a normal delivery. Two days after, during our rounds we would ask her if she feels any contractions, any pain and she would answer there was none. Finally the OB decided to do a Cesarean Section, meaning we would deliver the baby operatively. So the mother was scheduled for an operation. After the preparation was made, OR was started and I was not the one who assisted in the OR, I manned the Emergency Area. Few minutes after the OR has started there was a call inside for our Surgeon. I immediately called from my cellphone our Chief of Hospital who is already on His way home. This could be serious, it was only during rare times that our OB would refer to the Surgeon. After finishing with a patient in the ER i went inside the OR to see how things are. And VIOLA! there in the bassinet i saw the strangest looking baby I have ever seen. She was so red as if the first layer of the skin was stripped off. She got 4 fangs as if looking like a vampire, with a cleft lip. I hurriedly took my camera and snap some shots. You see I go on duty with a stethoscope on my hand and a camera on the other to document some rare cases like this. Even though the baby has no life anymore we still blessed her with water as to Baptized her. The Surgeon was called out because the OB can't make an incision on the uterus, the intestines are adhering all together, as if the uterus has been eaten up. The mother didn't feel any contractions whatsoever because the uterus was contracted all this time, it was described as hard as a rock. The uterus was so damaged that it was impossible to save it for the mother to bear child again for this was her first pregnancy. There was a buzz in the hospital that the baby has eaten up her mother's uterus.

The relatives scaredly accepted the baby, which was buried at that same day. The next day while doing our rounds there was already a circulating story about this patient. Being in the province you will still hear that these people still believes in witchcraft, quack doctors, self proclaimed prophet and so on and so forth. It seems that the mother left her husband to be with another man who got her pregnant, his ex made a curse that no man will ever have her. Well this was their interpretation of why she had this kind of pregnancy. Well as i have already told you we are in the province where this reasoning is still acceptable.

Our explanation....the patient had a postmaturity pregnancy where lot of factors has contributed to it. It may be because the baby is big for her age, take note that this patient has no check-up at all, no vitamins taken, and she was in a lot of stress. Maybe at the course of pregnancy, she did had mild contractions that she didn't take seriously of, the baby became distressed died in the process. Infection sets in, the mother didn't had any fever because the infection didn't entered her blood stream, it was contained in the uterus. Self defensively the uterus contracted to prevent further damage, when the infection slowly is finding its way out, the intestines and the recognized the threat, they plunged into the affected part of the uterus and made themselves some form of barrier to stop the infection causing them to adhere with each other. The baby is in the early stage of decomposition that is why she looked that way and she did have some abnormalities which may be due to nutrition, genetics, stress and many other factors. So to all the mother to be out there, and also those planning to be one. Have your regular check-up, take your vitamins and relax pregnancy is just temporary...but your child would be permanent.

FIRST

2008-06-09T02:28:00.000-07:00

Well this will be my first post...a first of many I hope. I am in a hospital so faraway from the city, between mountains and sea and even if it is a secondary hospital meaning...we can do Obstetrical and Surgical operations we are lacking in so many facilities. The nearest we can refer to would be 6 hours of long, bumpy drive and still it is just a Provincial Hospital with same equipments, same facilities as we have. The only difference would be is that they are departmentalized. (They have Specialists in Pediatrics, Surgery, Internal Medicine, Obstetrics and Gynecology and Anesthesiology respectively.) With us we only got our Chief of Hospital who happens to be a General Surgeon, one Pediatrician, two Anesthesiologists, and most of us including me are General Practitioners. So just imagine our everyday dilemma of not having a consultant to refer to. So anyway the next hospital we can refer to would be 12-16 hours away depending on the weather condition. This is the way by sea, and too risky, if the patient is in a very critical condition the worst could happen here and you can't do anything about it. The other way would be by air yes it is only 45mins.-1hr travel BUT the price is too HIGH as in HIGH as you are flying...one should be willing to spend 65 gran just to charter a private plane to get to Manila , and it can go as high as 75 gran if you like to be escorted by a private doctor, plus his accommodations in Manila and the fare back to where he came from. Only a handful in that area can afford this, because most of the patients we cater to are the poorest among the poorest. We call them " http://www.com/ as in ""walang-walang-wala" sorry people. And also a large number of them belong to the Minority group. So the saying "Bawal Magkasakit" should be plastered boldly in the front of the hospital. Most of us GP's(General Practitioners) came from Manila we stay there for about 10-11 days before another set of doctors comes in for their monthly duty. While the anesthesiologists stay for about 15 days each. So this Blog would contain mostly of my experience there...and maybe some about my chaotic and sometimes boring life. So thank you for reading the first ever...and hopefully not the last post. Have a Good and Healthy day!