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Friday, September 30, 2011

Not another Lipoma!

The exclamation mark at the beginning of the post is warranted! I have written before about the God's scheming to keep surgeon's on their toes by making sure the intra operative findings completely differ from the initial clinical assesment as was the case during the mysterious hernia here.. I'm quite prepared to give this phenomenon a name maybe Techknowdoc's Law (on the lines of Murphy!)

A 40 something Koli (fisherfolk community) woman presented to us with a swelling over her left buccal surface not visible from the outside but fairly big on the inside. It was bothering her as it would interfere with her eating and brushing. Now that I have mentioned brushing, this lady would not use toothpaste but tobacco powder (an unfortunate but very common occurrence in rural India)

This simple piece of information was enough to make us suspicious and we did the usual palpations and tests.An ultrasound exam revealed an echopoor mass with some solid component and no conclusion was offered by the radiologist on the first exam. She also turned out to be hypothyroid which prompted us to think in terms of an aberrant thyroid mass (lingual thyroid is common too)

She was advised an MRI and a thyroid uptake scan both of which were not done as she was not in a position to afford expensive tests. A repeat ultrasound after 2 weeks showed that the mass was not shrinking after a course of antibiotics, and the neck scan revealed normal thyroid tissue and a reactive lymph node on the opposite side.

She was getting very restless and offered a blanket consent for removal. We decided to go ahead and operate. After preop preperations were complete, she was taken in the OT and was given local anaesthesia with an anaesthetist standby. As soon as we took the incision, a grand yellow soft mass popped out.


Once again, the infamous Lipoma (which has baffled us before - as seen in this post) had surfaced in the most unlikely of locations with the most unusual presentation. This was easily removed and the patient was sent home about 2 hours post the surgery! She walked in for a follow up after a week with the mouth wound completely healed and the histopathology report confirming a simple Lipoma. 

I guess the God's were giving us a break with this fortunate happy ending! This case will be prepared as a case report and sent to a medical journal for publication. Hopefully, it should end up published.

Thursday, September 15, 2011

A rose by any other name....

'What's in a name? That which we call a rose by any other name would smell as sweet,'

 Famous last words!

Clearly, when this was penned, people used to name their children after a lot of thought and purpose. Nowadays, it's difficult to tell whether a name is a name or a fruit or a calender month or something discovered by dropping utensils (sorry to all my chinese readers but pin pong whaa is just too easy to poke fun at). Now, I'm no stranger to keeping funny pet names, gosh, I call my own son Toofan (the storm) for God's sakes, but that's a pet name, not a serious, first name / christian name or whatever you want to call it.

An advantage of being a surgeon is that you get to hear all sorts of names coming into your surgery. Not all are unusual but in my opinion most would never get discovered if it was just a medical consult. There it's usually Mr. X or Mrs. Y but no first names or pet names.

My first experience with an unusual name was in Delhi where one of the nurses was named 'Bubble'. If this wasn't enough to tickle my already funny bone, they pronounced it as Buh Buh ll.

As recently as yesterday, we operated on an appendix patient who was named 'Beauty'. Not a name that means beauty or signifies beauty but 'Beauty'!

Can you imagine the torment the poor child would go through in school, college and walking into an interview!
Good Morning Sir/Madam, my name is beauty and I am a team player. Yeah right! It's just difficult to take these names seriously. Sure I may be biased but it's just bad parenting!!

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