Monday, June 22, 2009

PILES, So What .......?

Buasir je, tak payah susah-susah lah.....



Not everything that comes out of the anus is faeces
Not everything that protrudes out of it is hemorrhoids

An old man came to the hospital with severe anal pain and faecal incontinence (tak boleh kontrol berak le tu). He was dehydrated and emaciated and this thing (picture) was seen in the anus.

It was a fungating anal cancer which was later confirmed by a biopsy. So I told him the diagnosis. Buasir je... saya telah jumpa doktor panel banyak tahun, dia kata buasir, tak bahaya pun!
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So this is the problem; "patients come with rectal bleeding and prolapsing anal mass - hemorrhoids until proven otherwise" No examination done, given some medications and sent home. Subsequent visits - same medications. No reassessment or referral to the appropriate specialists.
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This is what happened to this unfortunate old man. Deadly cancer treated as a common disease; piles. The biopsy was reported as malignant melanoma; a rare but deadly cancer. On top of that, his chest X-ray revealed multiple metastases (cancer spread) . . . . . . . . . . . . . . . . . and the old man's days now are numbered .... KKM-DKP.
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Ironically, this is not just 'a case I saw', I have seen many cases including referrals treated for months as hemorrhoids / piles / buasir / ti cheng / zhi chang or what ever you like to call it - but actually are anal or rectal cancers. Once I attended an surgical workshop on PPH (new technique of treating hemorrhoids); the patient was already put to sleep and when the legs were lifted, poop.. out came an anal cancer. That case was pre-selected by a surgeon for the demonstration! . See, hemorrhoids are probably not just a simple disease to diagnose.
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If you are primary care doctors, think of a differential diagnosis beside your provisionals.
And if you are a patient, always ask for an explanation especially when things are not as expected.
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and TABIB BUASIR is not part of the solution.
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Any way, KKM-DKP stands for kubur kata mari, dunia kata pergi ..............

1 comment:

hani@debumelukut said...

my brother in law is facing this problem at the moment.He is in hkb right now for some test and what not.We have no idea about this kind of cancer until recently.like u said, we thought it waz merely piles.I wish to see more of ur article regarding this..