MAXIMUM TOLERANCE

This glass splinter was in the foot of a 31 yr old female for 1 year. She tolerated the pain every time she steps on it. Why? She did not have the money to have it removed. until  we opened  up a district hospital in Samal Island catering to poor people with a PHIC coverage.  It took 10 minutes to remove the glass fragment to alleviate a poor woman's suffering.

SELF MEDICAL DIAGNOSIS

At last, my ebook is now available. Hi-light and right Click the thread below:

http://www.amazon.com/Self-Medical-Diagnosis-Self-Medicate-ebook/dp/B00ENIFKPU/ref=sr_1_1?ie=UTF8&qid=1380524831&sr=8-1&keywords=self-medical+diagnosis+dr+cagape

NECROTIZING ENTEROCOLITIS

88 yr old with abdominal pain. I knew she needed surgery, an acute abdomen. But almost all odds were against her except her will to live longer. Her children wanted her to live longer too. If I decided not to operate, the cardiologist, anesthesiologist, pulmologist and the nephrologist ( yes she has kidney failure) would readily agree. But no, she really needed surgery and I had to stick my neck out and save her.
I thought she had ruptured appendicitis with the signs and symptoms she was manifesting. All diagnostics failed to make the right diagnosis. When I opened her abdomen, dark bloody ascites came out.
I am very happy to have pursued the surgery. She is well and alive today.

BODY RESPONSE TO A HUMAN MISTAKE

The picture shows a gaping wound on the chest with the ribs exposed, pus oozing inside and air coming out of the wound.
This patient had a close tube thoracostomy ( a tube inserted into the lungs) for PNEUMOTHORAX ( accumulation of air in the thoracic cavity outside the lungs) because of tuberculosis. The tube was not taken out immediately ( about 7-10 days) after evacuation of the air ( thru chest x-ray). It stayed inside far too long ( 1 month). She developed EMPHYEMA ( pus formation in the lungs). From a simple air to development of pus, this is a human mistake which cannot be taken for granted.
When she was referred to me, this was her chest x-ray.

The left lung collapsed; fluid ( pus) filled the cavity up to the 3rd rib. The heart is pushed to the right and the cavity still has air.
I removed the old tube which was not draining and inserted a new one. Then I closed the wound to prevent air from entering the wound. After surgery, no leakage was noted; pus drained out thru the tube. I sent the patient home. All of these procedures done in my clinic saving the patient  a year's salary of her father.
A week later, she came back with an open wound; the tube hanging on her side by a thread and pus oozing out from the wound. Suture again and close the wound? That I did. 4 days later, the wound dehisced with pus flowing on her side. I removed the chest tube; debride the area and packed the wound to allow the pus to drain out.
10 days later, she came back well looking, pinkish on the face; not dyspneic anymore and she is on her way to recovery. Allowing the human body to heal itself is the best decision that I made for this patient.

INSTRUMENT OF HAPPINESS

From this 

to this. What happiness have I given to an individual? Priceless. From a n outcast who smells 10 feet away
to a normal person. And to think that I was the instrument in making this happen..

HISTOPATHOLOGY

Not all masses or tumors need to be send to the laboratory for histopath. Many people do not know that this add to the expense of a simple surgery. All medical practitioners had one year of PATHOLOGY and with this we can readily recognize whether a tumor or mass is malignant or not by gross examination after excision. Outside of medico-legal cases, histopathology of tumors adds to the backlog of pathologists' work diverting their attention from the more important cases they have to see. GANGLION CYST, BAKER'S CYST, SEBACEOUS CYST AND LIPOMA are some of the cysts that do not need histopathology. They are glaringly so obvious that sending them to the laboratory is almost a sin. A surgeon must know them without blinking an eyelash. But because of the recent surge of layman's "medical knowledge", they insist that these tumors have to be send to the laboratory. It is their money anyway. But what if all these biopsies were charged to the government? They add to the wastage and misuse of funds. 

WHAT COULD BE WORST

See what fear had done to a person. This is not cancer. This is CYSTOSARCOMA PHYLLOIDES;  a benign tumor of the breast. Because of fear, this patient refused to have a simple breast mass on her breast removed about 4 years ago. She bore the smell, the bleeding and the messy situation for 2 years before coming back for surgery. And she is only 53 years old. Money was not the question. Her family was willing to shoulder the expenses. It was not education either. She is a college graduate. She just simply cannot accept the idea of going under the knife. She tried taking all kinds of herbal medicines including all the capsules and tablets supplied by her sister from the States who claimed that those could cure cancer or whatever she had. They were playing doctor all these time. It took me an hour to remove the tumor. See the result of the surgery in a few days.

TIME

Time heals, so they say. But not in medicine nor in health or illness.
The above patient was diagnosed  with a HYDROTHORAX ( fluid in the lungs) 2 months before coming to me. A tube was inserted into his side and left there for 2 months. He had a simple fluid in the lungs but 2 months later he now have EMPHYEMA ( pus in the lungs). Advertently or inadvertently, the tube was left too long. The patient was told the tube has to stay there because the drainage was persistent. Of course, the tube was irritating the tissues around it causing the continuous fluid formation. His doctor's parameters in caring for a chest tube  were awry. The patient now has no other option but to to have THORACOTOMY; open the lungs, remove the pus, insert a tube and wait for about 3 to 5 days when the PNEUMOTHORAX ( air in the thoracic cavity - not inside the lungs) would have been evacuated via a WATER SEAL DRAINAGE. 

VON RECKLINGHAUSENS DISEASE

I was watching NATIONAL GEOGRAPHIC  featuring mine clearing in Vietnam. This reminded me how tedious it is to remove underground mines planted by US forces and communist guerrillas in the fields of Vietnam. They have to pick them one by one.
Same with these skin tumors. I have to clean them one by one, infiltrate anesthesia, excise and suture. These take hours and I would prefer to do abdominal laparotomy than to hand pick these tumors one by one. 

SPOT THE DIFFERENCE

All of them need surgery. The first picture is an out-pouching of the subcutaneous tissue ( underlying tissue below the skin which determines the smoothness of our skin or the wrinkles of it) caused by deep scratching or injury on that area. The second one is a severe cellulitis causing vesicle formation caused by a skin infection. And the third one is an abscess formation caused by a deep infection.
Knowing the etiology of the disease determines the treatment. The first one's surgery needs a deeper cut to find the artery supplying it. The second only needs a puncture. And the third one needs the removal of the underlying tumor ( sebaceous cyst).
Now, who would ever think that a person who never went to medical school would know that? Everybody who is not a doctor. Hahahahahahahaha. Self medication all over the world has risen more than 90%. People treat themselves before they go to a doctor with herbal medicines; over the counter antibiotics; potions and salves and whatever their neighbors' expert opinion because they have done it themselves.
Practically speaking, we are going back to the middle ages unless you go to a doctor.

MEDICAL FINANCE

Doctors are great money finders. We work our butt but we are well compensated. The problem is we don't know how to handle money. We believe in people who say they are good in investment and we entrust our money to them for investment or we join them in a project. At the end we are always holding an empty bag and a lot of debts. Name the business and I have invested on it except pimping ( of course).
+Suzi Orman is one of the finance gurus that I follow. Though her shows were aired in cable before, today I miss it. She had a lot to say about personal investment and denies almost every other person who invest or buy more than they can afford. But I had yet to hear from her which investment last a lifetime. All institutions which were the monuments of stability ( Lehman, AIG, CITICORP) went down and they were all the apple of +Suzi's eye.
Watching NATIONAL GEOGRAPHIC and Discovery Channel, people who owned castles and empires went down to their graves thinking that their inheritors would live their lives with nothing to worry about money. Many of these descendants live to see their castles foreclosed by the government or taken from them.
Now, where does a simple surgeon place his money for safe keeping for the future when his hands would have tremors and would be incapable to suture a small vessel. At those times, young surgeons will take over and the old surgeon would be left with the memory of shouting in the operating room: "NEXT"!!

PABLO VICTIM'S HAND - follow up

The fisherman's hand 2 months after injury with daily dressing of SILVER SULFADIAZINE cream impregnated on sterile gauze bandage after a thorough wash with soap and water. No povidone iodine. Nothing else. This is just to prove that PSEUDOMONAS infection can be cured with soap and water. Any chronic infection whether admitted in the hospital or at home and infected with hospital acquired bacteria can be readily cured with ordinary soap and water and not a cocktail of 3rd generation antibiotics.

HUMAN SUFFERINGS

I had this patient yesterday who never consulted a physician all her life. She never got sick probably or was self-medicating for whatever illness she had. For 6 months she noticed a mass on her right thigh the size of a pingpong ball. This did not disturbed her  nor gave her something to worry about. So she thought. 3 days ago, the mass suddenly became painful and enlarged to this size almost double the size of her thigh. She was 64 yrs old and thought she could do without a doctor. But yesterday, the pain became so unbearable and she could not walk because of the pain. And she did not have any money despite the fact that she was once the general manager of  a Yamaha School of Music. She started to have fever. She was forced by her husband to seek consultation. When she came to the clinic, I came to realize I was facing an elderly who does not believe in Western Medicine but who obviously need it. The abscess was as large as the picture full of pus. Incision and drainage is necessary pronto. After much convincing and a long wait while they count their money ( in front of the secretary of course), I did the I and D. The abscess contained as much as 1 liter and the smell was as putrid as a 3 days dead cat. I did the procedure in the clinic to save cost. But the whole office smelled for 24 hours. Why would a person suffer if treatment is available? Why does fear rule our lives?

VACATION

I usually go on vacation every 2 years outside the country and indulged on all the perks that I can afford: night golf in Shanghai, eco tour in Penang, night life in Mumbai, elephant ride in Bangkok and gold shopping in the suks of Amman, Jordan. But my clinical mind does not go on vacation. I worry about the patients I left behind in the care of my associates. And then, these patients have my mobile number. Not a vacation really.
One time I was in the middle of my golf swing in Singapore when my patient who had RIGHT HEMICOLECTOMY (partial removal of ascending colon ) because of colon cancer  called up to tell me that her poop was always watery ( normal post op with this procedure). Well, wouldn't you mind if someone is calling you because of that? I shank the ball and got a double bogey. Lost Php 3,000 on the bet. What did I do or say to her? Weigh her poop whether she could hit the Guinness. Hahahahahaha

PATIENT'S SURGERY DECISION

To this day, I still do not know why one patient agrees to surgery immediately or procrastinate. Is it to the tone of my voice which does not fluctuate or change whatever the situation is?
Take for instance 2 patients who need surgery of the breast with the same tumor size, same preoperative diagnosis, same financial situation, same stable psychological background. They both come on the same day; one after the other. And yet, one agrees to the excision while the other postpones it for a simple reason that she just don't want the surgery today. For 31 years, I have been searching for the bug or virus or wind or wall paint that could influence their decisions.  Since both of them come with their husbands who readily agree to the surgery, one agrees to the procedure and the other goes home.
Sometimes, I come to believe that two whisperers are influencing my patients; whether they be angels or demons do not matter.
And these musings have brought me to conclude that we could not be alone in this world and that Somebody is making the decision for  us.

EBOOK

In a few weeks from now, my publisher + Bob Bare will launch my book "SELF-MEDICAL DIAGNOSIS" under the management of his general manager here in the Philippines +Mecos Pacana.
We hope that with this book, we could help a lot of people who want to know what disease they have prior to going for consultation especially those who are living  in the third world where medical specialists are out of their reach financially and logistically.
<http://www.amazon.com/Self-Medical-Diagnosis-Self-Medicate-ebook/dp/B00ENIFKPU/ref=sr_1_1?ie=UTF8&qid=1380524831&sr=8-1&keywords=self-medical+diagnosis+dr+cagape>

THIS IS THE HAND NOW

This is the hand now after partial amputation of the  of the gangrenous fingers.

AGGRESSIVE APPROACH TO SURGERY

I have been aggressive in doing surgery lately. Because of financial constraints a lot of patients cannot afford to go to the hospital  to have a minor surgery done under general anesthesia. Most if not all minor surgeries go under general anesthesia because the patient cannot bear the pain and the size of the tumor is too big for a local anesthesia.  I have done hemorrhoidectomy, varicocoelectomy and excision of breast masses the size of a child's ball ( 10cm x10cm) under local anesthesia all because of the patient's limited resources.

The above tissue came from a a big subcutaneous tumor ( LIPOMA) on the side of the patient's abdomen the size of  12cm x 12 cm. I have become bolder and bolder nowadays. But it only took me 30 minutes to remove it sparing the patient to spend Php 35,000 for a hospital surgery.