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Update January 2019


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Update by Natrakorn Paewsoongnern
 
 
 

Doctor's Consultation  by Dr. Iain Corness

 

Anyone for a Nephrectomy?

You will most likely never meet someone who has had a Nephrectomy. The secret code comes from the word ‘nephros’ (kidney) and ‘ectomy’ (removal).

As we were blessed with two kidneys, removal of one does not spell the end of the world, but it isn’t an easy road to hoe. I speak from personal experience.

My kidney and I decided we were not compatible in November 2018 when I looked in the toilet after the morning motion and a bowlful of bright red blood was staring back at me.

No other symptoms had me confused. If my urinary symptoms were threatening dire things, then I would have expected some pain. But none. I plugged on that day until I was no longer passing any urine at all, but now the discomfort of an over extended bladder was making itself evident. I staggered into our Urology department begging for help to decompress my bladder.

Modern technology is amazing. In less than five minutes a catheter was passed into the bladder, complete with mini-camera and the inside of my bladder lay open for medical scrutiny. Amazing.

This showed us that blood was coming down the right ureter (tube from kidney to bladder) and that the next step would be an X-Ray scan of the kidney, scheduled for the next day. In the meantime a catheter was passed into the bladder and we waited for the scanner.

A scan is a painless procedure (just like an X-Ray) and my urologist Dr. Pornchai, asked me if I wanted to look at the scan, to which I eagerly agreed. After all, I had already decided this would show a calculus (stone) in the kidney itself. Dr. Pornchai sadly turned the screen in my direction. There was no calculus, just a mass of cancerous tissue where the kidney used to be. There was also involvement of the arteries and veins in the region. This was not going to be a simple procedure.

Much discussion with the specialist surgeons ensued with BPH vascular surgeon Dr. Sujit joined by other colleagues from Bangkok and Dr. Pornchai. There would be precious little elbow room at my surgical table.

The plan was that Dr. Pornchai would remove the kidney while vascular surgeons removed the diseased artery and vein and grafted where necessary. Several hours work. And exacting work too.

On the appointed day I was anxiously admitted to the ward, dressed in surgical clothes and on a gurney, transported to the Operating Theatre.

By the time I was pushed into the theatre proper I was no longer anxious, but just wanted it all to begin. Let’s get the show on the road! I’ve never been good at waiting.

My next experience was a sort of magical mystery tour. Morphine can take you anywhere, and in my case it did. I was in an ICU with no idea of what I was doing there. I had no real sense of even where I was, and why! For a while I was in the UK, and the next, Northern Thailand.

Angels in white hovered around which seemed to have a calmative effect to counteract latent panic, which unfortunately did break through on several occasions (I am told).

I have recollections of calling out for somebody, anybody, to tell me where I was as I thought I was back in Australia. My big son, the doctor who practices in Australia, became a kind of life line to reality. In retrospect I’m sure I must have been a right proper pain in the A for him.

From there it was assistance to get out of bed and help with the agonizing trip to the toilet that was the most pressing need. (I have never been able to pee in a bottle while lying down.)

The pee shuffle is so important as it is necessary for the Urologists to ensure that the remaining kidney is doing its job, and volume of urine passed is the best measurement. By the way, it’s not easy standing there holding onto the wall with one hand, and the pee bottle with the other and not saturating your feet. So far, so good! Carpet slippers remained dry.

After one week it was time to fly solo and bundling all the grapes, chocolates and other edible goodies together it was off home and walking around the walls to get to the toilet after either of the children helped me up from my sofa, a task with 40 odd stitches running north to south not being easy, nor pain free. However, I can now get out of the chair unaided. Another giant step for mankind.

At the time of writing this, it is now three weeks post-operation. I can drive my car (slowly) and even toast some bread while standing in the kitchen. All very mundane, but all part of the rehabilitation.

Life actually revolves around the abdominal scar. Everything you do is connected to your belly button. The pink one button is far more important than you imagine. No matter what you do, the belly muscles are needed to stabilize the body and contract. Not fun.

And so I approached 2019, one kidney short but high in hopes. I am walking, albeit slowly. I am watching my diet to restrict salt (note: chips without salt are not worth eating), my racing car sits under a cover getting ready for me to get behind the wheel and I get ready for the fifth pee of the day and it is only 10 a.m.

I thank all my friends and those who have helped spur me on. You have been appreciated more than I could tell you.


Rhinoplasty - a most common cosmetic procedure

How you look is most important these days. Especially for women. Show me a young (or old) woman who can walk past a mirror without having a peek. Cosmetic surgery is even thought by many to be the answer for personal problems.

There are many cosmetic surgical procedures available these days, and in fact, rhinoplasty (nasal remodeling) is one of the commonest cosmetic surgery procedures carried out in Thailand, since Thai ladies all seem to want the foreign larger style nose. For example, when our daughter was born, my wife said she was worried about the size of baby’s nose - it wasn’t big enough!

Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

One of the biggest problems facing cosmetic surgeons is not the surgical techniques, but the patient with unreal expectations of what the procedure is going to do for them. The person with a poor self-image may decide that the reason they are not the most popular person in the group is because of the shape of their nose. Unfortunately for this group of people, nasal remodeling will not change their personality, they will still not be the most popular person, and the rhinoplasty will have “failed”.

The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you’re physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate.

Age is also an important consideration. Young teenagers, a group that is very aware if their appearance, may not be ideal candidates for rhinoplasty, or most cosmetic surgery for that matter. There are growth spurts which change the features, and psychologically teenagers are not really mature enough to make decisions which will affect their appearance for the rest of their lives.

One other factor that must always be taken into consideration, when contemplating cosmetic surgery, is that in medicine there are no 100 percent guarantees. All surgery and anesthesia carry risks. In the situation of rhinoplasty, that risk is very low, but there is still that little uncertainty, that nobody can deny. There is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesic. After surgery, small burst blood vessels may appear as tiny red spots on the skin’s surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; but when an ‘open’ technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible, but again, no guarantees.

In about 10 percent of cases, a second procedure may even be required to correct a minor deformity. Again, such cases are unpredictable and happen irrespective of the skill of your surgeon. Living, breathing human beings are all different, never forget that.

So let us assume that you have understood all the pitfalls, have a realistic attitude, and still want that nose remodeled. The next step is to indicate to the surgeon just what you are aiming for. This is when you bring in your 100 photos of Tata Young! But once again, it is not all that simple. The surgeon has to look at what you currently have and see if your bone structure can support the nose of your choice.

Remember, too, that the vast majority of cosmetic procedures are not covered by the usual health insurance policies. Another point to remember is that after the operation you will have a swollen, bruised face, which takes a few days to settle. Take some holidays to allow this to fade.

Finally, be sure that your surgeon really is a Board Certified Cosmetic Surgeon. All doctors have skills in basic surgery, but rhinoplasty is not basic. This is surgery that changes the way the world sees you. Pick the best!


Slipped a disc recently?

Would it surprise you if I said that ‘vanity’ was one of the prime reasons we get back pain? The real reason you get a bad back is because our forefathers decided we looked better walking on our hind legs, instead of all four. Just like a horse, the bones of our spines lock together nicely when we are on all fours, and weight can be carried easily on our backs. However, when we stand up and try and lift, it all goes pear-shaped from there. The spine was not designed to carry loads, or pick up loads, in the vertical position.

But unfortunately, lift and carry is a prime example of what we call on people to do, from mothers lifting babies to laborers lifting bags of rice. The presenting situation is one we meet only too often. The patient is doing something and suddenly everything locks up and they are immobilized, frozen to the spot. I was once called out to a factory toilet where the chap was bent over the urinal, and too afraid to move, the pain was so acute.

Back pain is one of the commonest orthopedic problems, and the often used terms such as lumbago, sciatica and slipped discs are spoken about frequently.

Let’s look at the “slipped disc” problem. First thing - discs do not “slip”. They do not shoot out of the spaces between the vertebrae (the tower of cotton reels that makes up your spine) and produce pain that way. The disc actually stays exactly where it is, but the center of the disc (called the nucleus) pops out through the edge of the disc and hits the nerve root. When this happens you have a very painful condition, as anyone who has had a disc prolapse (our fancy name for the “popping out” bit) will tell you. Think of the pain when the dentist starts drilling close to the tiny nerve in your tooth. Well, this is a large nerve! When the nucleus of the disc hits the sciatic nerve, this produces the condition known as Sciatica - an acute searing pain which can run from the buttocks, down the legs, even all the way through to the toes.

Unfortunately, just to make diagnosis a little difficult you can get sciatica from other reasons as well as prolapsing discs. It may just be soft tissue swelling from strain of the ligaments between the discs, or it could even be a form of arthritis. Another complicating fact is that a strain may only produce enough tissue swelling in around 12 hours after the heavy lifting, so you go to bed OK and wake the next morning incapacitated. And then you have to convince the employer that you did it on his time.

To accurately work out just what is happening requires bringing in those specialist doctors who can carry out extremely intricate forms of Medical Imaging called CT Scans, Spiral CT’s or MRI that will sort out whether it is a disc prolapse, arthritis or another soft tissue problem. The equipment to do these procedures costs millions of baht, and the expertise to use them takes years of practice and experience. This is one reason why some of these investigations can be expensive.

After the definitive diagnosis of your back condition has been made, then appropriate treatment can be instituted. The forms of treatment can be just simply rest and some analgesics (pain killers), physiotherapy, operative intervention or anti-inflammatories and traction.

Now perhaps you can see why it is important to find the real cause for your aching back. The treatment for some causes can be the wrong form of therapy for some of the other causes. “Self diagnosis” is dangerous!

So what do you do when you get a painful back? Rest and paracetamol is a safe start. If it settles quickly, then just be a little careful with lifting and twisting for a couple of weeks and get on with your life as normal. If, however, you are still in trouble after a couple of days rest, then it is time to see your doctor and get that definitive diagnosis. It is the orthopedic chaps you need to see.


HEADLINES [click on headline to view story]

Anyone for a Nephrectomy?

Rhinoplasty - a most common cosmetic procedure

Slipped a disc recently?