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.
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
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
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,
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
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
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
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
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
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
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.