Thursday, July 23, 2009

Tropical Fruit Season

Fruit season is a very much awaited time of the year in the rural areas of Malaysia. Plenty of delicious fruits are available freely (for those who have the trees) or cheaply (if you need to buy it from the mushrooming roadside fruit stalls) .



For some rural folks and the orang asli (the aboriginies) - those who kais pagi makan pagi, they don't need to go to work, they just stay home and eat. They just need to pluck the fruits and eat. So they eat and eat and eat.


Sometime you see complications... especially if they swallowed the seeds. Tropical fruits are not like apples; thick 'flesh' and small seeds. Furthermore, some fruits you have to swallow the seeds, otherwise no 'uumph'. Mangosteen and rambai are examples of this type of fruits.

Last night a senile elderly lady, was brought in to the hospital with constipation and severe anal pain. Abdominal X-ray showed dilated colon packed with hundreds of 'seeds. I spread-opened her buttock, and I could see those seeds impacting the anal canal. I had to manually evacuated the seeds. Memanglah sakit tapi lepas tu lega. They are manggosteen seeds, and that suprised me. A mangosteen usually has six fleshs; only one or the most two have seeds. That means she really ate plenty of those fruits probably more then a hundred in several days.



When I was a medical officer in Mentakab, an orang asli girl presented with abdominal colic caused by similar problems.... and I had to dig out hundreds of 'setol' seeds. She literally picked up the fruits from the floor of the jungle and ate them. I had to sedate her with Ketamine and removed the seeds with my finger till clear.


A fellow physician once told me; The most honorable thing a surgeon does is to digitally relieve a patient with an impacted rectum !


Hard objects impacted in the colon cause ulcers in the colonic mucosa by pressure necrosis. These ulcers are called stercoral ulcers. Not uncommon, the ulcers perforate through and caused peritonitis. Few years ago when I was in the university, an old lady presented with peritonitis. I took her to OT and opened her abdomen. To my astonishment; I found hundreds of rambai seed in the peritoneal cavity. What happened was she ate the rambai and swallowed the seeds; her colon was packed with the seeds resulting in the colonic perforation. I had to pick up all the seeds, washed the peritoneal cavity and exteriorised the colonic perforation as a loop colostomy. Later when she was well, I closed the colostomy.


This picture showed ripe rambai fruits. Each fruit contains three glistening, usually sweet and sour flesh with a seed in the middle. You don't need to chew them, just put in your mouth and swallow them.
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The lesson is: If you really like these fruits, eat them by all means. But please don't swallow the seeds. Otherwise someone has to stick his finger into your arse.

Saturday, July 11, 2009

Tired and Betrayed

Last Thursday was a busy day for me, I had several surgeries and some endoscopies. As I was about to settle down just before midnight (malam Jumaat beb), a lady was brought in with difficulty in breathing. She was pale as a sheet, her hemoglobin was 3.2 gm/dL(normal > 11). As I was asking where and what could be the source of her chronic blood loss, I smelled something bad from her body; smell of necrotic tissues.

After much persuation and explanation including by her sister (whom I thought I've seen before)she reluctantly showed me this;
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The usual thing . . . . . . . . . . . . . . . . . . !
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Advanced ulcerating cancer of the right breast with chronic bleeding from the ulcers.
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If you observe the surrounding skin, there were multiple nodules. There are cancerous metastases called stellite nodules. The other breast were also involved, with peau d'orange (skin lymphatic infiltration)
She forewarned me not to do anything to the tumour as she was at present on treatment; homeophatic medicine and after this is going to another bomoh in Melaka. All she wanted was the treatment for the breathlessness.
The breathlessness was caused by severe anemia. So I transfused her with 4 unit of concentrated blood (packed cells). When she felt better, she insisted on going home. I asked her who was doing the dressing all the while, the answer; my sister. I turned to her sister; have we met before? Yes, I was a head-nurse in xxxxx department when you were in the university.
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Oh Tuhan, apa dah jadi ni? (O God, help me!)
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I put much efforts to make Malaysian ladies seeking proper treatment for their cancers, to avoid unnecessary deaths and morbidity. I gave lectures to nurses and women groups. Promoting breast-self-examination and mammogram screening. But now I have a senior nurse who I knew personally, yet is 'encouraging' her own sister to go to the bomoh. No wonder, there are bomoh bragging that doctors and nurses are among their patients. Once I had a patient (hernia surgery) who is a bomoh patah(he treats fractures) himself, he boasted that many doctors went to him for their fractures.
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Common chaps, if you don't believe in what you practice (modern medicine), then stop practising. Don' t misled others. Go out and do something else !
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As for the lady, she chooses to end her life in a miserable way with other people avoiding her due to the foul-smelling cancer on her body.
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As for me, I am tired and feel betrayed by my own colleagues . . . .