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Monday, March 26, 2007

Alternative Medicine? Boon or Bust!

I know there are a lot of supporters for homeopathy and ayurveda but there is a time and place for everything.

This patient who came to the casualty on sat. had been transferred from a pvt hosp with all investigations done with a diagnosis of multiple liver abscesses. Now the thing with this is that one person had reported them as abscesses and the other as cancer spread.

The lady got admitted and as things would have it she got a little better but she started getting jaundice. Now this could be because of hepatitis, hepatocellular failure (liver failure)or the cancer spreading.

Some godforsaken well wishers told her that jaundice can be definetely cured with some ayurvedic medicine available in her village.

This morning she decided to take a discharge against medical advice and go there to get ayurvedic treatment.

The problem is that if this is a cancer there is nothing that ayurveda, homeopathy or even allopathy can do to cure it. What ppl must understand is that there are many causes of jaundice and some can be cured easily and others can't. Generally viral jaundice will clear in two weeks even without treatment and that sometimes is attributed to a miracle cure to alternative medicine because they give it for 15 days.

I have no problem with alternative medicine but please think about this lady who will probably die of cancer spread in two months where she could have lived for upto 2 years with the proper supportive medical treatment. So, I'm not exactly sure if I can be satisfied with my knowledge of healing if I can't break through traditional belief's that friends and relatives will give better advice than you're Doctor!

This might be a little more clear to medicos but I will be happy to answer questions if they do come up from non-medicos!

Nasogastric Tube or Abdominal Drain?

Before I begin this post, let me, for the benefit of non-medicos, explain what a NG tube and an Abd Drain is. NG tube is used to decompress the stomach by simply acting as a tube with holes through which stomach contents come out through the nose. Its used routinely for obstruction in the abdomen.
Abdominal Drain is a tube which is left in the abdomen and comes out through the skin and is used to remove pus or fluid from the abd cavity to a bag outside usually after a surgery.

Now that my title makes sense, let me take you into the abdomen of this old lady who came to us after being operated at a pvt hosp some 14 days prior to coming to us. She had stones in her pancreas and was operated and a major procedure was done which involved joining two pieces of intestine and draining the pancreas.

When she came she had a NG tube through the nose and an abd drain in her already as she wasn't recovering. The drain was draining some amount of pus and the NG tube was draining an abnormally large amount of fluid.

To cut things short she wasn't doing well and we suspected that the intestinal anastomosis (joining the two) was leaking so we decided to re open her up.

What we saw at the table shocked even my rather cool Dr. Lefty. The NG tube which is supposed to be in the stomach had somehow come right through the stomach wall and was lying in the abdomen. The fluid that was being drained by it was actually the abdominal cavity and it was frank pus.

Speculation was that there were two possibilities:
1.) The stomach wall had died and given way and the NG tube was therefore in the abd.
2.) The NG tube perforated and basically tore through the stomach wall.

Anyway, the tear was stitched and the drains replaced and the previous anastomosis was alright so nothing else could be done.

The lady passed away in the ICU. It was a very very strange occurence and till date no one knows how that tube came out of the stomach. For once it was not a Municipal Hospital at fault.

Spinal Anaesthesia Can Break Your Back!

Ok this is late so its going to be short.

We give spinal anaesthesia to numb the lower half of the body when we want to operate in that region.

So, this young fellow who was to undergo a hernia surgery came to the ot and was made to sit on the operating table so we could give him anaesthesia. The anaesthetist managed to find the space and administered the drug. As soon as this is done the patient is made to lie down quickly so that the drug concentrates at the lower part of the body and doesn't track upwards.This guy is made to lie down in a hurry and suddenly we hear a loud CRASH.

The ot table broke into two and the head end of the patient went down taking the poor fellow with it. Now remember that this guy is paralysed waist down because of the anaesthesia. So we jump in there to catch him before he hits the ground and the whole room is in Shock!

Just one point to highlight...What if this happened when the surgeon had applied a knife to the patient? Just imagine what could get cut by mistake!!!

P.S. This happened on the 27th of Jan. The table has since gone for repairs and hasn't yet returned.

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