Conscience? Is there any left? Or just an empty shell like a cyst?

I have a 46 year old man, who came for his annual blood check because he has underlying ischaemic heart disease, diabetes melitus, dyslipidaemia, hypertension and gouty arthritis. On his first visit, he did not have his list of medications with him. So I told him to come back the next day with his medications. He did come back the next day, with this list:

  • T. Metformin 1000mg TDS
  • T. Januvia (Sitagliptin) 50mg OD
  • T. Amaryl (Glimepiride) 2mg OD
  • T. Micardis Plus (Telmisartan / Thiazide) 80/12.5mg OD
  • T. Concor (Bisoprolol) 5mg OD
  • T. Norvasc (Amlodipine) 5mg OD
  • T. Zocor (Simvastatin) 20mg ON
  • T. Aspirin 100mg OD
  • T. Allupurinol 300mg OD

Based on his latest blood results, his uric acid levels were normal, his sugar was well controlled, had microalbuminuria and BP readings were around 110-130 / 70-80 mmHg.

Now, what is wrong with the list? One thing for sure, just by looking at it, you know that he spends an awful lot of money each month just for these. He told me that he spends an estimated of 500-600 bucks each month. The second question that comes into mind was, “What’s he working as?”. Wouldn’t you be curious too? Guess what? He sells pork. That’s right. He’s a butcher who sells pork. Either he’s really a successful butcher, who earns tons of money each month, or someone is sucking this poor man’s pockets dry. Mind you, with that amount of money each month, you can pay for a car installment.

The second problem, he has gouty arthritis. Why would you start someone on a Thiazide when he has attacks regularly? And then you counter the gout with Allupurinol. This does not even make any sense.

Third, does he really need all those anti-hypertensives? He’s basically taking all 4 groups. It’s not like his blood pressure is that bad that he needs all 4 of them.

When you stop and ponder, you really do wonder why this is happening. Is this really about the money? Or was it really for the patient’s benefit. You be the judge.

Sigh.

To all budding and new doctors out there, do not be like a cyst.

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A cyst is an anechoic lesion with no internal echoes present. All dark and gloomy. Please do NOT be like that. Be compassionate. Think of your patients. Rather than treating them with the most expensive drugs out there, treat them with the appropriate drugs instead, what’s best (expensive does not mean it’s the best) for him or her. And by doing so, would definitely give you a sense of satisfaction, and happiness too.

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Looking young is an offence. And so are fatty livers!

It’s not the first time that I have patients telling me that I look young. It depends on how you look at this issue.

  1. I’m incompetent. I’m young and so, I am inexperienced.
  2. I look young for my age.

I rather take the latter. However, I do not disagree with the fact that experience do come with age. The best answer that I could give to them was, “Why.. thank you!”. However, recent events that showed how incompetent most new and upcoming doctors (at least from where I am) these days, I’m not surprised why patients do make such statements. I am not smart in any way. I am sure there are a lot of smart doctors out there. However, what irks me is the attitude of the newer generation of doctors. They have this “Ah, I can’t be bothered.” kinda attitude. I mean why? Why choose this profession when you do not even care? Not just a mere observation, but I’ve been reading and hearing lots of horror stories too. Oh well, I could rant all day long but I guess I’m “young” too. So I can’t be bothered.

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Anyway, I think this is the easiest abnormality one can detect through ultrasound. A fatty liver. As you can see, the liver is much whiter as compared to the kidney. In a normal person, both the kidney and the liver have almost the same contrast and intensity. Fatty liver seems like a big taboo in my community. When I tell my patients that they have a fatty liver, their face changes as if it is the end of the world. It’s really fun to see their reactions, well, at least for me. Bad bad me. Then again, look at the bright side, at least I get to drill it directly into their heads that they should watch what they eat and to exercise.

So, how fatty is your liver?

Dead SSD. And a bling-y testicle gland.

If you are wondering what is an SSD, it stands for Solid State Drive. My OCZ Vertex 3 gave up on me last night. Rather disappointing, since I got it just a few months back. I guess these things do happen on and off. The thought of churning out another chunk of money just to get another SSD depresses me. Things do not come cheap these days. And especially when you want to have a decent drive, you do not have much of a choice.

Anyway, let’s have a look at this.

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I’ve been doing random testicles scans and most of the guys that I’ve scanned find it ackward to have their testicles scanned too, but yet they pay to do it. I wonder why. The image above showed microlithiasis of a testis. Rate of occurrence is estimated about 5% in the male population, which is associated with an increased risk of testicular cancer and could cause infertility in certain males too. And best of all, there is nothing you can do to cure/treat it. The only option is to monitor your testes every now and then to screen for any unwanted growth.

Now, what I find fascinating is that the testis looks like a bling. Or bling-bling. It literally shines on the screen of the monitor. And the response that I get from my patients was “Whoa… why so bling?”. Hence, I’ve now categorized them as the ones with the bling-bling testicles.

I Wonder.

Some times, I do think that I think a lot. However, there are times, I don’t actually think much too. And when I do think of stuff, some may be important, some may not be. It is a feeling that I do not how to describe it in words. Even as of now, just by thinking and writing all this down, I don’t even know whether this was necessary.

Image for today.

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This is an ultrasound scan from a 35 year old lady. She had no complaints of dysmenorrhoea or menorrhagia. Just for a follow up knowing that she had this in her. And best part was, she kept this problem to herself until I had scanned her. When she was asked if she had any problems, or any scans done prior to this that showed any abnormalities, she said there was none. Some people, ugh.

So what is this? Apparently it was either a dermoid cyst or a haemorrhagic cyst. Since in the end, she told me that it was there for more than a year, I guess it was pretty much a dermoid type.