Importance of Keeping Old Medical Records

It is important that patients keep a copy of their medical records.

One importance is illustrated in this case.

For one reason or another, my clinic records of a patient got lost.  I asked the patient to bring her copies and reconstructed her records in my clinic.

old_records_retrieved_june_2017

ROJ@17jun12

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Breast Cancer Survivor Carmelita Brillo – 19 Years in Remission

In 2011, I wrote and posted in my blog:

Breast Cancer Survivor Carmelita Brillo – 13 Years in Remission

Breast Cancer Survivor Carmelita Brillo – 13 Years in Remission

by Reynaldo O Joson on Thursday, September 22, 2011 at 7:02pm

In 1998, Ms. Carmelita Brillo underwent a modified radical mastectomy for an invasive ductal carcinoma on one of her breasts in Manila Doctors Hospital.  After the operation, she received a full course of radiotherapy.  She did not receive chemotherapy.  Four years after, in 2002, she had a recurrence in her lung.  I treated her with Tamoxifen, after 10 months, the lung metastasis completely disappeared. She took Tamoxifen for 5 years.  She is now 13 years in remission as of this writing in September 22, 2011.  She is now 77 years old.  We both thank God for this long remission.  A word about her red polka-dot dress.  She has been wearing it for the past 10 years whenever she would come to me for a check-up.  She considers it a good-luck dress.

 

carmelita_brillo_11sept22

Taken in 2011 September.


June 10, 2017 – she came for check-up.

She is now 19 years in remission.

Take note of her red polka-dot dress. She has been wearing it for the past 17 years whenever she would come to me for a check-up.  She considers it a good-luck dress.

IMG_5139

 


ROJ@17jun12

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Lunge as an effective remedy to plantar and ankle stiffness and inflammation

A lunge can refer to any position of the human body where one leg is positioned forward with knee bent and foot flat on the ground while the other leg is positioned behind.de6417970bae92e3_reverse_lunge_fpI used the word “genuflection” for laypeople to facilitate understanding and doing the exercise.

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Last April 2017, a 57-year-old Filipino female with a breast concern told me she has been having left ankle pain for one month already.  When I examined her ankle, I did not see any gross abnormality.  I diagnosed her to have a non-specific left ankle pain with stiffness and inflammation. I advised her to do lunges.  She noted down my instructions of “25x/day.”  She also noted down as part of her personal medical record “for pain on the right innerside of my left heel.”

June 10, 2016, when I saw her again for her breast check-up, she happily reported the pain disappeared after 2 days of doing the lunges or genuflections.  She was indeed very happy. I told her to do the exercise everyday.


Personal Experience

I had plantar fasciitis late 2014 to 2015 lasting for about a year. It disappeared late 2015 one week after I did stretching exercises, particular lunges, with no recurrence up to now – 2017. I am still doing daily lunge exercise.


Lunge is an effective remedy to plantar and ankle stiffness and inflammation. Try  it.



Side comments:

  1.  I am a general surgeon.  I still practice general medicine like the patient I mentioned above – managing her ankle pain.  If there is a fracture or torn ligament or tumor, I refer the patient to an orthopedic surgeon already.
  2. Based on my diagnosis, I did not have to order for an x-ray or MRI.  I rationalize my use of diagnostic procedures based on my clinical diagnosis.


ROJ@17jun12

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Scars after Mastectomy

Different outcomes in the scars after a mastectomy.

Beautiful Scars

Beautiful in the sense there is a fine incision scar; there is no widening of the scar; there is no hypertrophy (thickening) of scar; and there is no keloid.

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IMG_5091

 

ROJ@17jun3

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Importance of Doing Monthly Breast Self-Examination

Monthly Reminder!

Once you discover anything unusual, particularly a dominant mass, consult a breast specialist right away. The breast specialist will do a clinical breast examination and give you a diagnosis. He may order some diagnostic tests if needed. Don’t procrastinate the consultation and treatment, if needed, that is being advised by the breast specialist. If the dominant mass is benign, then you are relieved of the anxiety of breast cancer. If the dominant mass turns out unfortunately to be cancer, have it treated right away by the breast specialist. Don’t wait for the cancer to grow bigger and spread to the point there is nothing much that can be done.

Catch a breast cancer, if it develops, as small as possible! You can catch it as small as one centimeter by doing monthly breast self-examination.

breast_brownish_nipple_discharge_mass_fibrocystic_2014dec (1)

Catch a breast cancer, if it develops, as small as possible! You can catch it as small as one centimeter by doing monthly breast self-examination.

IMG_3559

Catch a breast cancer, if it develops, as small as possible! You can catch it as small as one centimeter by doing monthly breast self-examination. Do not wait for it to rupture as prognosis becomes poorer and there may be nothing much that a breast specialist can do to help.

IMG_1999

Catch a breast cancer, if it develops, as small as possible! You can catch it as small as one centimeter by doing monthly breast self-examination. Do not wait for it to grow to a huge size and to spread as prognosis becomes poorer and there may be nothing much that a breast specialist can do to help.

IMG_4952

ROJ@17jun1

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Course of Breast Cancer Patients Who Died

Patient 1:  MDA

2016

49-year-old when first seen by me. Underwent modified radical mastectomy, left, with deltopectoral flap om 2011 (5 years before at age 44) for a 12-cm invasive ductal carcinoma.  Axillary nodes – 2/46 positive.  Underwent postop chemotherapy – fluorouracil, adriamycin, cyclophosphamide then radiation.  ERA / PRA – negative.

On consultation in 2016, multiple palpable nodules (recurrences) noted on the left chest area above the deltopectoral flap.  Palpable node on the right supraclavicular area.  Bone scan showed metastasis to left 2nd rib.  Chest x-ray showed a pulmonary nodule. Ultrasound of the liver was negative for metastasis.

Another chemotherapy regimen (unknown) initiated by a medical oncologist – received 2 cycles. No response.

Patient died within one year after 2016 consultation with me.


ROJ@17may24


To post more in the future.

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Gallbladder Polyps Recommended for Operation – SAD

Today, I was sad when I saw a seafarer patient who came in for a 2nd opinion.  He was recommended to have a laparoscopic cholecystectomy.  Ultrasound showed polyps 4 to 6 mm in size with no gallbladder wall thickening and patient is asymptomatic.  He was asked to prepare 120 to 160 thousand pesos for a laparoscopic cholecystectomy.

gb_polyps_lap_chole_2017may18

I am sad because I believe gallbladder polyps, especially those smaller than 1 cm and asymptomatic, need no operation.

I am sad  because I have been advocating a wait and see approach with no operation when not needed.

I have written several blogs on gallbladder polyps and have advocated against unnecessary operation, particularly for seafarers.

Gallbladder Polyps – Concerns of Seafarers and Others

Seafarer medical clinics which do not require operation for gallbladder polyps

Usual Clearance for Seafarers with Gallbladder Cholesterolosis

https://www.facebook.com/groups/1327847933955719/

Mission: Promoting the Health of Filipino Seafarers!



 

In an effort to reinforce my advocacy on no need for operation for gallbladder polyps, I searched again the literature today and I found this very important article.

http://pubs.rsna.org/doi/full/10.1148/radiol.10100273

Incidentally Detected Gallbladder Polyps: Is Follow-up Necessary?—Long-term Clinical and US Analysis of 346 Patients

Published in 2010

The management of GB polyps is currently influenced by concern for the presence or development of GB carcinoma.

In conclusion, we found no cases of GB malignancy in 346 patients.

Advances in Knowledge

•. The risk of gallbladder (GB) malignancy resulting from incidentally detected polyps is extremely low.
•. The risk of neoplasia in incidentally detected polyps is also extremely low, with none seen at diameters smaller than 7 mm.
Implication for Patient Care

•. Incidentally detected GB polyps measuring 6 mm or less require no additional follow-up.

Ergo, NO NEED FOR OPERATION (REMOVAL OF THE GALLBLADDER) FOR GALLBLADDER POLYPS – small ones and in asymptomatic patients

ROJ@17may18

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