Stay Safe Stay Healthy Amid COVID19 and Telemedical Consultation

There is this buzz phrase “Stay Safe – Stay Healthy” amid COVID19.

What does it mean?

STAY SAFE means to stay safe from being infected and dying of COVID19 infection.  It is not worth dying from COVID19 as it is something very preventable.  There are a lot of strategies on how to STAY SAFE FROM COVID19.  I will not elaborate here.

STAY HEALTHY means to stay healthy, not to get sick from preventable medical conditions and diseases aside from COVID19, particularly those that need medical and dental management in a hospital setting.  Examples – prevent accidents, dental fractures, diarrhea and vomiting from improper food ingestion, and other preventable medical conditions and diseases that may necessitate hospital management.  It is a hassle to get sick amid COVID19  (one of them is the screening for COVID19 before being treated and another is the transportation difficulty).  It is very expensive to get sick amid COVID19 (one of them is the expenses associated with screening tests for COVID19 and another is the use personal protective equipment used by hospital staff which are charged to the patients).  Lastly, it is risky to be treated in a hospital setting as the hospitals have a significant number of COVID19 patients and staff.

There are a lot of strategies on how to STAY HEALTHY.  I will not elaborate here.

Bottom lines on the strategies on STAY SAFE – STAY HEALTHY: MINDFULNESS OF THE RISKS AND DANGERS and VIGILANCE.

If one is not successful in STAYING SAFE AND STAYING HEALTHY, if there is medical concern, go for TELEMEDICAL CONSULTATION first.  Wait for the advice of the physicians in the telemedical consultation on what to do next, particularly on whether there is a need to go to a hospital or not.

stay_safe_healthy_roj_20jul13

stay_safe_healthy_telemedical_consultation_roj_20jul13


ROJ@20jul13 

Posted in COVID19, Telemedicine | Leave a comment

How to do self-examination of the thyroid in a telemedical consultation

How to do self-examination of the thyroid gland and the adjacent neck areas in a setting of a telemedical consultation

(self-examination includes inspection and palpation)

 

In a telemedical consultation of a patient with a thyroid concern, there are preparations that have to be made prior to the consultation, particularly on taking and submission of pictures and reading on how to do self-examination of the thyroid (read How to do self-examination of the thyroid by oneself)

The examination, particularly the palpation part, of the thyroid and the adjacent neck areas is done by both the physician and the patient.  The patient will be taught on how to do self-palpation and will be guided and supervised by the physician.  Preferably, there must be a third person who can validate the findings of the patient.

Pictures to be taken prior to telemedical consultation

Patient is asked to take still pictures and video showing the following and submitted to the physician for inspection (this will complemented by the webcam):

Patient has to have water to drink and to swallow to enable the trachea to move up and down during the picture taking.

There must be an adequate lighting in the room where picture-taking is to be done.

Still Pictures

Front view of the whole neck (with no dressing or coverage) with neck extended or stretched upward, from the level of the lower lip and ears to just below the collar bone.

Front view of the whole neck (with no dressing or coverage) but with neck turned to right side, from the level of the lower lip and ears to just below the collar bone.

Front view of the whole neck (with no dressing or coverage) but with neck turned to left side, from the level of the lower lip and ears to just below the collar bone.

Right side view of whole neck (with no dressing or coverage) with neck extended or stretched upward, from the level of the lower lip and ears to just below the collar bone.

Left side view of whole neck (with no dressing or coverage) with neck extended or stretched upward, from the level of the lower lip and ears to just below the collar bone.

Videos

1st set of video – front view with positions described in the still-picture instructions but with patient swallowing at least 6 times.

2nd set of video – right side view with positions described in the still-picture instructions with the patient swallowing at least 6 times and head turning side to side.

3rd set of video –  left side view with positions described in the still-picture instructions with the patient swallowing at least 6 times and head turning side to side.

Inspection by the Physician

Physician inspects the still pictures and videos submitted by the patient.  Inspection is complemented with the real-time webcam.  Physician may ask for more pictures if needed.

Palpation

Self-palpation by the patient guided and supervised by physician

(Preferably, a third person is around to validate findings of the patient.)

Expose the whole neck (remove all dressing or coverage) to be seen clearly through the naked eyes and to allow free palpation by the fingers.

Palpation of the Thyroid Gland

With the neck extended or stretched upward, using one hand, either right or left, place the thumb on one side of the trachea and the other fingers on the other side. Firmly but gently press on the side of the trachea using the flats of the fingers and not the tips.  Then, swallow.

While swallowing, feel for the thyroid gland and determine whether there is enlargement or there is / are nodules.   Normally and usually, the thyroid gland is not prominently palpable.  If the whole thyroid gland is prominently palpable but without nodules, then it is usually considered to be enlarged.

Normally and usually also, the thyroid gland does not contain nodule/s.

Do the palpation of the thyroid gland at least 6 times of swallowing until one is confident of the findings – no enlargement; possible or evident enlargement; no nodules, possible nodule/s, or evident nodule/s.

Palpation of the Sides of the Neck

To palpate the right side of the neck, turn head to the left.  Use the left hand to palpate the right side of the neck.  Using the flats of the fingers except the thumb, with the fingers pressed firmly, sweep gradually while palpating for any nodule from below the chin down to the collar bone. Do this gradual sweeping palpation at least 6 times until the entire right side of the neck is palpated and one is confident of the findings – no nodules, possible nodule/s, or evident nodule/s.

To palpate the left side of the neck, turn head to the right. Use the right hand to palpate the left side of the neck.   Using the flats of the fingers except the thumb, with the fingers pressed firmly, sweep gradually while palpating for any nodule, from below the chin down to the collar bone. Do this gradual sweeping palpation at least 6 times until the entire left side of the neck is palpated and one is confident of the findings – no nodules, possible nodule/s, or evident nodule/s.

 


 


ROJ@20jul12


Examples of pictures to be submitted to physician

Front view of the whole neck (with no dressing or coverage) with neck extended or stretched upward, from the level of the lower lip and ears to just below the collar bone.

front_view1ex

Left side view of whole neck (with no dressing or coverage) with neck extended or stretched upward, from the level of the lower lip and ears to just below the collar bone.

lat_view_lex

Right side view of whole neck (with no dressing or coverage) with neck extended or stretched upward, from the level of the lower lip and ears to just below the collar bone.

lat_view_rex

 

Videos

Video inspection of the thyroid gland and neck

https://youtu.be/gM7hE2FnqK0

Video inspection of the thyroid gland and adjacent neck areas – front view

https://youtu.be/8uHt4tWzXgA

Video inspection of the thyroid gland and adjacent neck areas – left side view

https://youtu.be/qVP2YC1X5a8

Video inspection of the thyroid gland and adjacent neck areas – right side view

https://youtu.be/_Nq8bmuQstU

Palpation of the Thyroid Gland

images1images2aimages3a

Palpation of the Sides of the Neck

images4



One can read the following for further learning:

https://www.youtube.com/watch?v=msbHLZQz8fk

https://stanfordmedicine25.stanford.edu/the25/thyroid.html

https://www.youtube.com/watch?v=-kfsG7p1hSk

https://www.youtube.com/watch?v=A6xVV8wiXZo

https://www.youtube.com/watch?v=Ed2WE7heOdU

 

Posted in Thyroid, Thyroid Self-examination | Leave a comment

How to do self-examination of the thyroid by oneself

How to do self-examination of the thyroid gland and the adjacent neck areas

(self-examination includes inspection and palpation)

  • By oneself
  • In a telemedical consultation guided and supervised by a physician


BY ONESELF

Be ready with a glass or bottle of water to drink and to swallow to enable the trachea to move up and down during the thyroid examination.

Have an adequate lighting in the room where the self-examination is to be done, especially on the neck.

Expose (remove all dressing or coverage) the whole neck to the naked eyes, to be seen clearly through a mirror and to allow free palpation by the fingers.

(Picture with mirror)

Inspection (Looking)

With the neck extended or stretched upward, through the mirror, look at the front of the neck (the whole span of the neck with focus on the central lower half).

(Picture)

While looking, have in mind the anatomy of the thyroid gland and where it is usually located, at the central lower part; important landmarks such as the thyroid cartilage and the two big neck muscles on the sides, the sternocleidomastoid muscles; and what to look for (enlargement or nodules in the thyroid gland and nodules representing lymph nodes on the sides of the thyroid gland usually along the two big neck muscles).

See illustrations:

Anatomy

What to look for

On the thyroid gland:

 

Enlargement

Nodules

 

On the side of the neck (along the 2 big neck muscles)

Nodules

 

 

Without drinking and swallowing water, look for unusual findings on the central neck and on the sides (enlargement; nodules on the thyroid gland; and nodules along the neck muscles).

While swallowing water, again look for unusual findings on the central neck and on the sides (enlargement; nodules on the thyroid gland; and nodules along the neck muscles).

 

Note down the findings on inspection:

Nothing unusual seen.

Possible or evident enlargement of the thyroid gland seen.

Possible or evident nodule/s of the thyroid gland seen; number; location – right lobe, left lobe or both or isthmus (the bridge between the right and left lobes).

Possible or evident nodule/s seen along the neck muscles; number; location.

 

 

Palpation (Feeling)

Stay in front of the mirror while doing the palpation.  Though focusing on palpation at this time, one can go back anytime to do inspection through the mirror to recheck previous inspection findings and check or validate findings on palpation.

Palpation of the Thyroid Gland

With the neck extended or stretched upward, using one hand, either right or left, place the thumb on one sides of the trachea and the other fingers on the other side. Firmly but gently press on the side of the trachea using the flats of the fingers and not the tips.  Then, swallow.

While swallowing, feel for the thyroid gland and determine whether there is enlargement or there is / are nodules.

Normally and usually, the thyroid gland is not prominently palpable.  If the whole thyroid gland is prominently palpable but without nodules, then it is usually considered to be enlarged.

Normally and usually also, the thyroid gland does not contain nodule/s.

Do the palpation of the thyroid gland at least 6 times of swallowing saliva or water until one is confident of the findings – no enlargement; possible or evident enlargement; no nodules, possible nodule/s, or evident nodule/s.

Palpation of the Sides of the Neck

To palpate the right side of the neck, turn head to the left.  Use the left hand to palpate the right side of the neck.  Using the flats of the other fingers except the thumb, with the fingers pressed firmly, sweep gradually while palpating for any nodule from below the chin down to the collar bone. Do this gradual sweeping palpation at least 6 times until the entire right side of the neck is palpated and one is confident of the findings – no nodules, possible nodule/s, or evident nodule/s.

To palpate the left side of the neck, turn head to the right. Use the right hand to palpate the left side of the neck.   Using the flats of the other fingers except the thumb, with the fingers pressed firmly, sweep gradually while palpating for any nodule, from below the chin down to the collar bone. Do this gradual sweeping palpation at least 6 times until the entire left side of the neck is palpated and one is confident of the findings – no nodules, possible nodule/s, or evident nodule/s.

 

Note down the findings on palpation:

Nothing unusual palpated.

Possible or evident enlargement of the thyroid gland palpated.

Possible or evident nodule/s of the thyroid gland palpated; number; location – right lobe, left lobe or both or isthmus (the bridge between the right and left lobes).

Possible or evident nodule/s palpated along the neck muscles; number; location.

 

 

As mentioned, one can repeat inspection if needed to verify findings on palpation until one is confident of the findings.  Likewise, one can do more than 6 times of palpation of the thyroid gland and the sides of the neck until one is confident of the findings.

 

If nodule/s is/are palpated, then further evaluation has to be done.

 

After the physical examination, inspection and palpation, one can have such illustrative findings:

 

Posted in Thyroid Self-examination | Leave a comment

The reality of cancers – NED not Cure

The Reality of Cancers
 
The term no evidence of disease (NED) is often used with cancer when there is no physical evidence of the disease on examination or imaging tests after treatment. No evidence of disease means the same thing as complete remission or complete response. It does not, however, mean that a cancer is cured. With most cancers, there is a chance it could recur at a later date.
 
 
Why Doctors Don’t Say Cancer Is “Cured”
Doctors rarely use the term cure when talking about solid tumors—even if there is a 99% likelihood a cancer will never come back. It is impossible to know if there are micrometastases present in your body—that is, areas of cancer spread that are too small to be seen on imaging studies.
 
 

ROJ@20jul10

Posted in Cancer Consciousness Week | Leave a comment

Telemedical consultations as practiced by other physicians and institutions

Telemedical consultations are the new normal amid and after the COVID19 crisis.

Many physicians and health care institutions are promoting telemedical consultations for the safety of patients and physicians alike.  Telemedical consultations first as much as possible.  Face-to-face consultations, only when needed.
Telemedical Consultation – New Normal_roj_20may15_16
Each physician and each health care institution has its own set of policies, system and payment scheme for telemedical consultations.
Some would allow teleconsultations only during the COVID19 crisis.  Some would continue to have them even after the COVID19 crisis (ROJoson Way).
tmc_covid_pandemic
Some would allow use of any platform such as cellphones (SMS, voice calls); Viber (message, voice and video chats); Facebook Messenger (message, voice and video chats); emails; web-based teleconferencing apps like Zoom and Google and privately-established apps; etc.  Some would specify what to use.
Some would require video telemedical consultations (I prefer Zoom complemented with Facebook Messenger or Viber). Some do not, just voice calls or message chats.
Some would give the service for free and some with a fee.
Some require payment first before teleconsult.  Some allow payment after the teleconsultation.
book_pay_consult
Some would charge medical consultations through phone calls, Viber and Facebook Messages.  Some do not.
lao_cellphone
tele
SO, BEFORE GOING FOR TELEMEDICAL CONSULTATIONS, KNOW FIRST THE SYSTEM, POLICIES AND FEES INVOLVED.


roj_telemedical_consulation2_roj_20apr17
You can avail of my ROJoson Telemedical Consultation with Video Medical Examination preferably using ZOOM.

Step 1:

Read Primer on ROJoson Telemedical Consultation:

https://sites.google.com/site/rojosontelemedicalconsultation/primer-on-rojoson-telemedical-consultation

Step 2:

If interested, request Facebook Friendship of Rojoson Telemedicalconsultation (https://www.facebook.com/rojoson.telemedicalconsultation.9)

Step 3:

Request appointment through cellphone

SMS or text ROJoson at 09188040304 with the following details:

1. Complete name, age and sex

2. Concern to consult ROJoson:

3. Desired date of consultation:

4. Cellphone #:

5. Email address:

6. Facebook account (name or link to profile):

Step 4: After completing the steps above, wait for ROJoson’s response through SMS.

 



asian

mmc

csmh

centuria

mdh_mediwifi2

 


ROJ@20jul8

Posted in Telemedicine | Leave a comment

Clinical breast evaluation for the primary health care physician

breast_evaluation_roj_17nov14

Image | Posted on by | Leave a comment

ROJoson Medical Consultation Recording – Samples

As years pass by, I keep on refining my medical consultation recording.

Samples are seen below. Will start with one and then add more in the future.

med_records

imperial_f_20jul4_record-1

See also:

Medical Recordings in the Medical Clinic

https://rojosonmedicalclinic.wordpress.com/category/medical-recording/

Posted in Medical Recording | Leave a comment

Common presenting breast concerns of Filipino patients

From a survey of 34 OB-GYNE respondents (March to April 2020):
From a survey of 31 General Surgeon respondents (May 4 to May 31, 2020):
 
Common presenting breast concerns of Filipino patients:
 
1. Breast mass (most common)

2. Breast pain
 
3. Breast check because of fear of cancer
 
4. Nipple discharge (least common)
 

From a survey of 34 OB-GYNE respondents (March to April 2020):
OB


From a survey of 31 General Surgeon respondents (May 4 to May 31, 2020):
surgeon_survey_20jul6
ROJ@20jul6
Posted in Breast Wellness | Leave a comment

Advice on how to respond to initial symptoms

See:

https://sites.google.com/site/rojosontelemedicalconsultation/advice-on-how-to-respond-to-initial-symptoms


Every human being feels some symptoms which may suggest some diseases.
The symptoms can occur anytime of the day and any place with no evident or obvious triggers or causes, at least at the first second or first minute it is felt. At its onset, every human being has the right to be alarmed because of possibility of the symptoms being a forerunner of a definite disease, which may be curable or not curable.  Only time will tell what will happen in the next seconds, minutes, hours, days, months and even years.  Just wait and watch and monitor closely with the hope (which includes prayer), that everything will turn out alright.
The best hope (and prayer) is for the symptoms to spontaneously disappear in due time and soon.  The next best hope (and prayer) is for the symptoms not to be part of a medical condition called disease.  The next best hope (and prayer) is for the symptoms, if diagnosed already as a medical disease, to be something curable in due time and soon.  The next best hope (and prayer), if there is a diagnosed disease already, is for it to be able to be treated easily, with non-invasive procedures, with short downtime, and with the least expense.
Fortunately, majority (as high as 90%) of symptoms felt at the start, at anytime, anyplace are nonspecific and will regress or resolve spontaneously even without medical intervention.  Again, one has just have to wait and watch and monitor with the best hope and wish (and prayer).
One should not panic right away and do irrational intervention.
One can be alarmed and anxious but one should not panic.  Just wait and hope for the best.
What to do during the wait and hope period?
MONITOR.
Monitor the symptoms.
Monitor to study the symptoms in depth in terms of their detailed characteristics.
Monitor to note the frequency in a day,  whether they occur while sleeping (siesta or night sleep), whether they occur during daytime (morning or afternoon) or night time,  whether they occur upon waking up, etc.
Monitor their state of development – progression (becoming more severe); steady or no progression; on and off; decreasing in severity; etc.
Monitor for associated or accompanying symptoms.
Good news – if there is no definite pattern to suggest a medical disease, that is, if there are no tell tale or clear cut signs of a known medical disease and if they are on and off and without progression.
Bad news – if there is a definite pattern to suggest a medical disease, that is, if there are tell tale or clear cut signs of a known medical disease and if they are regularly present and worse, if with progression.
If there is a definite pattern to suggest a medical disease or there is doubt, consult a physician right away.
Examples:
A patient complained of “nahihirinan” when drinking water.  It occurred only twice one day apart.  For the past one month, there is no recurrence of the complaint.  Diagnosis: Non-specific nahihirinan (or choking).
A patient complained of right breast pain one month before. It was mild and on-and-off and does not coincide with menstrual period. There are no other associated symptoms on the breast.  Breasts has no mass and no abnormality noted at all.  Diagnosis: Non-specific breast pain.  There is no pattern for a specific medical disease or condition.



Every human being feels some symptoms which may suggest some diseases.  The symptoms can occur anytime of the day and any place with no evident or obvious triggers or causes, at least at the first second or first minute it is felt. At its onset, every human being has the right to be alarmed because of possibility of the symptoms being a forerunner of a definite disease, which may be curable or not curable.  Only time will tell what will happen in the next seconds, minutes, hours, days, months and even years.  Just wait and watch and monitor closely with the hope (which includes prayer), that everything will turn out alright. The best hope (and prayer) is for the symptoms to spontaneously disappear in due time and soon.  The next best hope (and prayer) is for the symptoms not to be part of a medical condition called disease.  The next best hope (and prayer) is for the symptoms, if diagnosed already as a medical disease, to be something curable in due time and soon.  The next best hope (and prayer), if there is a diagnosed disease already, is for it to be able to be treated easily, with non-invasive procedures, with short downtime, and with the least expense.  Fortunately, majority (as high as 90%) of symptoms felt at the start at anytime anyplace are nonspecific and will regress or resolve spontaneously even without medical intervention.  Again, one has just have to wait and watch and monitor with the best hope and wish (and prayer).  One should not panic right away and do irrational intervention.  One can be alarmed and anxious but one should not panic.  Just wait and hope for the best.
See also:

ROJ@20jul1

Posted in Non-specific Symptoms | Leave a comment

Protocols before admission to a hospital amid COVID19

Admission protocols will differ from one hospital to another.

The public should know about these protocols.

They should ask their physicians / surgeons before having themselves admitted to avoid the hassle of not knowing the protocols and expenses due to ignorance.


Hospital-1 (most hospitals have the following protocols)

For operations (non-urgent)

  • Clearance by attending physician / surgeon
  • Negative COVID RT-PCR test within 14 days
  • Negative chest x-ray within 14 days
  • Official clearance by an Infectious Disease Specialist

For non-operations

  • Clearance by attending physician / surgeon
  • Negative chest x-ray within 14 days

 

Attending physician / surgeon should have a negative COVID RT-PCR test within 14 days



Hospital-2

Non-urgent operations should be done within 7 days after a negative COVID RT-PCR test of the patient


To be continued

Posted in COVID19 | Leave a comment