Breast Cancer Survivor Johanna Gopaco – 10 Years in Remission

Johanna Gopaco from Palawan underwent modified radical mastectomy in March 11, 2010 in Manila Doctors Hospital. She was 32 years old then.  Histopath: invasive ductal carcinoma with negative nodes. She underwent postoperative adjuvant chemotherapy (6 cycles of CAF) in Palawan.  After the chemotherapy, there was no other additional treatment.  She was on symptom-directed cancer surveillance. In March 10, 2020, 3 to 4 months from today (19nov16) [when she came to me for check-up],  she will be 10 years in remission.  She is now 42 years old.  She is happy and wants to serve as an inspiration to other breast cancer patients by having a picture with me.  We both thank God for this long remission.

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Her auntie, Raymunda Cresencia, was also my patient before.  Ms. Cresencia was cured of breast cancer and died of causes other than cancer in December 2017 (34 years after being operated for her breast cancer).

In 2013, I posted this:

Breast Cancer Survivor Raymunda Crescencia – 30 Years in Remission

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Ms. Raymunda Crescencia, a public school teacher from Palawan, was 38 years old in June 13, 1983 when I did a modified radical mastectomy on right breast cancer in the Philippine General Hospital.  She did not receive any postoperative adjuvant treatment.  Today, July 23, 2013, she came to Manila to see me because of her leg skin problem.  She is now a retired teacher at age 68 and 30 years in remission from her breast cancer.  We both thank God for this very very long remission.  A breast cancer survivor indeed.  A patient cured of breast cancer.


ROJ@19nov16

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Breast Cancer Survivor NenitaM – 10 Years in Remission

NenitaM underwent partial mastectomy in November 6, 2009 in Manila Doctors Hospital. She was 52 years old then.  She had a frozen section done but result was non-committal. So a wide excision was done. After the operation, the histopathology showed mucinous carcinoma.  She refused another operation.  She did not have receptor assays done. She had no additional treatment, just monitoring.  She decided on symptom-directed cancer surveillance. In November 2019, she is now 10 years in remission and enjoying her life.  She is now 62 years old.  She does not want people to know she had breast cancer.  We both thank God for this long remission.

nenita_m_19oct31

ROJ@19oct31

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Prayers of ROJoson and Patient Before Operation

Prayers of Surgeon and Patient Before Operation

Before an operation, the surgeon and the patient can pray these ways together, one after the other:

For the Surgeon to Pray:

Heavenly Father, please take my hands and guide them.

Grant me the strength to help my patient (NAME).

The knowledge and wisdom to diagnose his/her surgical needs.

The skill to perform the needed operation effectively, efficiently and without complications.

 Please be beside me on this operation as I rely on you, the greatest of Healers.

Amen.



For the Patient to Pray:

Heavenly Father, please grant me full acceptance of the surgery which awaits me.  Let this be the relief which I seek for my medical condition.

Make skilled the work of my surgeon (NAME) and that of his team for it is unto their knowledge and skill that I entrust myself for healing.

I pray that this procedure will be done effectively, efficiently and without complications and that my recovery will be speedy and complete.

Amen.




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ROJ@19oct21

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Thyroid Disorders – “You doctors are so confusing”

Retrieved and saved this from my yahoogroups post written in September 2011

September 3, 2011, in my Saturday clinic in MDH, I had a patient with a thyroid concern.  He has a 4-cm nodule on the right lobe of his thyroid gland which was noted 5 months ago. He has seen other doctors before me and he came to me for another opinion.
As has been my practice, whenever a patient come to me for second or nth opinion, I don’t usually ask right away what were the opinions of the previous doctors.  As much as possible, I don’t let the opinions of the previous doctors influence my evaluation and what I have to say to the patient and his relatives in terms of diagnosis and my recommendations.  It is only after I have given my diagnosis and opinions on medical management that I ask for what the patient has been told by the previous doctors.  This is more out of curiosity.  Sometimes, I don’t ask anymore and oftentimes, I don’t ask for the names of his previous doctors and their respective advices to avoid any repercussion.
In this particular patient, I did what I usually do for patients coming for a second or nth opinion. After I did my focused interview and physical examination, aided by written explanation and analysis and with the use of drawings and illustrations, I told him chances are he has a colloid adenomatous nodule (a non-cancer thyroid disorder).
Before I took a look at all diagnostic tests that were done on him by the previous doctors, I told him the following:
“If you have thyroid function tests done, I expect them to be normal as you have a thyroid nodule and a normal pulse rate.”  [True enough, the results of his thyroid function tests were normal as I predicted.]
“If you have an ultrasound done on your thyroid gland, if the result shows cystic or complex mass, that will support my diagnosis of a colloid adenomatous nodule.” [True enough, the result of the ultrasound showed the term “complex mass.”]
Integrating the results of the diagnostic tests with my clinical evaluation (based on the symptom and sign data that I got from interview and physical examination respectively), I told him that I was 95% sure that his thyroid nodule is a colloid adenomatous nodule.
I then told him the options for further management, diagnosis-wise and treatment-wise.  Diagnosis-wise, I recommended a needle evaluation and biopsy.  If the result of the needle evaluation and biopsy supports the diagnosis of colloid adenomatous nodule, he has the options of surgical and non-surgical treatment (trial of medical treatment). If the result unfortunately shows something in favor of cancer, then the treatment is surgical or operation.
After hearing my explanations and recommendations, he was quite quick in consenting to a needle evaluation and biopsy which I did in my clinic.  The main reason why he was quite quick in accepting my recommendation was because he was afraid of surgery and ALL the doctors he had previously seen, which included endocrinologists and surgeons), recommended SURGERY RIGHT AWAYHe was told by an endocrinologist that there is a high chance that the nodule is CANCER because he is a MALE.
Using a hypodermic needle, I was able to aspirate 3-cc of brown fluid.  After aspiration, there was a marked decrease in the size of the thyroid nodule.  With these findings and the appearance of the specimen that I smeared on a glass slide which was suggestive of colloid gel, I told the patient I would now increase my degree of certainty to 98% to 99% that the thyroid nodule is a colloid adenomatous nodule.  I told him, though, we still have to await the result of the microscopic examination of the specimen (biopsy) for a definitive pretreatment diagnosis.
The patient left my clinic markedly relieved that he has a 98 to 99% chances of NOT having a thyroid cancer and that he has an option for a non-surgical treatment.  He said he will be able to enjoy the Lion King play in Singapore on September 11, 2011.
However, before he left my clinic, he made a friendly comment to me:  “You doctors are so confusing.” 
NOTE1: I am happy to help this patient based on what I think should be done .  I am a surgeon but I don’t operate left and right.  I operate only when indicated and needed.
NOTE2: This incident, especially, the parting comment of the patient, serves to reinforce the requests of my former students to update my 1986 book on “Thyroid Surgical Diseases.”  (See my Facebook Wall: 2nd Edition or 2nd Book on Thyroid Diseases? – August 19, 2011)  The main objective of this book was to attempt to clear up confusion in the management of patients with thyroid disorders.   In this book, I have a chapter with the title: “Pitfalls in the Management of a Patient with Thyroid Problem.”  The circumstances in the management of the patient described above are reflective of what I included as pitfalls in this chapter.

ROJ@19oct20

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Buying Medicine in Drugstore – Quantity – ROJoson Medical Clinic Advisory

ROJOSON MEDICAL CLINIC ADVISORY
BUYING MEDICINE IN DRUGSTORES – QUANTITY
Buying the quantity of drugs prescribed by the physician

You are and should not be required to buy the exact quantity of drugs after you are given a prescription by a physician even if you have enough money.
If the medicine prescribed is for one week and is for observation whether it will be effective or not and whether there will be side effects, just buy initially a quantity for a few days, say 2 to 3 days. If no side effects and the medicine is working, go back to the drug store and buy the rest of prescribed quantity.
This is to avoid wastage of the medicines. Physicians may change the medicine in a few days if there is a report of side effects and no improvement. You may find it difficult to return the unused medicine.

PART OF ROJOSON PATIENT-CENTERED CARE MANAGEMENT PROGRAM
PART OF ROJOSON PATIENT EMPOWERMENT PROGRAM

 



Today, 19oct12,  a patient of mine commented that she usually buys medicine in installment (or initially, fewer than the quantity wrote by the physician in the prescription pad). She said this is to avoid wastage (sometimes physician changes the medicine right away and difficulty in returning the medicine).
 
I told her I have been advising my patients to do the same (not buying initially all the prescribed quantity).
 
This conversation with the patient prompted me to issue this advisory so that other patients can learn from this approach.
 
Examples:
If I prescribe an antibiotic for an infection, although I will put the quantity number of the antibiotic amounting to a full treatment course supply, example 21 capsules, good for 7 days, I will advise the patient to buy good for 3 days initially.  I will advise him or her to observe the outcome of taking the antibiotics for the first 3 days, if there is side-effect and if there is response or not.  If there is no side effect and there is response or at least no progression of the infection, I advise him or her to go back to the drugstore and buy more for the next 4 days.  If there is a side effect or no response, he / she is allowed to call me for a decision making – to change the antibiotics and to shift to another antibiotic.  At times, I give the patient a reserved prescription for an antibiotic that will be substituted in case of side effect and no response to the initial antibiotic.
I try to help my patients in avoiding wastage (including money) in buying medicines.

ROJ@19oct12

Posted in Medical Prescription, ROJOSON MEDICAL CLINIC ADVISORIES | Leave a comment

Gestures of Excellent Patient Experience

I consider the following as gestures of excellent patient experience with me:

  1. Delightful Feedback to ME
  2. Gifts (Foods and others)
  3. Pictures with ME (ROJoson’s Patient-Fans)
  4. Hugging

Delightful Feedback to ME

https://www.facebook.com/rjoson2001/media_set?set=a.10151089252480800&type=3

Gifts (Foods and others)

https://www.facebook.com/rjoson2001/media_set?set=a.10153204866350800&type=3

Pictures with ME (ROJoson’s Patient-Fans)

https://www.facebook.com/rjoson2001/media_set?set=a.10151780396430800&type=3

Hugging Patients


ROJ@19oct9

Posted in Hugging Patients, Patient Experience, Uncategorized | Leave a comment

ROJoson Medical Clinic Notices in Facebook – 2018 Continual Refinement

Will continue to post ROJoson Medical Clinic notices on clinic schedule and changes in schedule in Facebook.

I think I started posting ROJoson Medical Clinic notices in Facebook in 2013.  Here is the evidentiary record.  I have been doing this since then.

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Latest:

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Continual Refinements for 2018:

  • Post at least 2 weeks before any decided changes.
  • Repost at least every week.
  • Post in FB Timelines; ROJoson Medical Clinic; ROJoson Breast Wellness Clinic; ROJoson Thyroid Wellness Clinic; Reynaldo O Joson 2; Reynaldo O Joson Page.
  • Place a tag (ROJOSON MEDICAL CLINIC NOTICE) for easy retrieval.
  • May post notices of NO clinics (if known) months in advance for the benefit of those patients from the provinces and abroad who will be availing of discounted air-fares.

Benefits for patients:

They know my clinic schedule.

They know changes in my clinic schedule.

They can plan their visits to my clinic.

They will be saved from unnecessary trips to Manila and to my clinic if I am not around.

rojoson_way

 

ROJ@17dec21


See also:

Advance notices on NO clinic sessions – ROJoson Medical Clinic

19oct1

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