ROJoson’s Patients Advised Against Unnecessary Operations and Procedures – A Registry – A Resumption

In December 22, 2013, I blogged to establish a registry of patients whom I have advised against an operation and procedure which I think was not necessary.

See below.

October 21, 2017, I will resume this project.

As I have said, this is one of the legacies that I will leave behind for my patients – saving them from unnecessary operations and procedures.

Actually, I have saved hundreds, if not thousands, of patients from unnecessary operations and procedures since I started my surgical practice in 1982.

Excluding unnecessary breast operations, the following medical conditions are usually those that I have saved from unnecessary operations and procedures.

  • Patients with normal thyroid and benign thyroid disorders, such as colloid goiter and thyroiditis
  • Patients with ganglion cysts which I usually just aspirate
  • Patients with gallbladder polyps which I just recommend watchful waiting
  • Patients with asymptomatic gallstones which I just recommend watchful waiting
  • Patients with parotitis and submandibular gland inflammation
  • Patients with nonspecific reactive cervical lymphadenopathy
  • Patients with small hemorrhoids
  • Others which I will try to recall.



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ROJoson’s Patients Advised Against Unnecessary Operations and Procedures – A Registry

Today, December 22, 2013, I will start making a registry of patients whom I have advised against unnecessary operations and procedures.  This will be retroactive, meaning, I will try to retrive data and information as far back as 1982 when I started my private practice on the patients who consulted me for second or third opinions and whom I have advised against an operation and procedure which I think was not necessary.

This is one of the legacies that I will leave behind for my patients – saving them from unnecessary operations and procedures.

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Below are some information that I have so far retrieved.

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A 2004 Write-up on ROJoson’s Acccomplishment.

“Since 2001, Dr. Joson has made his Department of Surgery and surgical staff relevant and proactive to the community health problems.  They have launched the following public health education and advocacies which fall under the theme of unnecessary procedures and health practices.”

Public Health Education / Advocacy

Beware of santol seed swallowing [See Appendix 8]It can cause intestinal perforations! It can cause unnecessary and premature death!

2001

NO to unnecessary (routine) circumcision  

2002

NO to unnecessary (routine) preoperative work-ups  

2002

NO to unnecessary mammography  

2002

NO to unnecessary breast mass operations  

2003

Beware of devastating aftermath of muriatic acid ingestion [See Appendix 13]

2004

The beneficiaries of these public health education and advocacy programs are the public, the health care professionals and providers and the Filipino people.

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Link to ROJoson’s Patients Saved from Unnecessary Breast Operations.

https://rojosonmedicalclinic.wordpress.com/category/patients-saved-from-unnecessary-breast-operations

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Cancer of the Appendix – 2017

Recently, September 2017, I encountered a patient with cancer of the appendix. This is rare.   This is most likely my third case of cancer of the appendix in my more than 30 years of surgical practice.

(Note: I have also encountered carcinoid of the appendix, another rare tumor of the appendix.  I remember I wrote a paper on carcinoid of the gastrointestinal tract in 1976 or 1977 during my residency in the Philippine General Hospital.  –https://rojosonsurgicalresidencyinpgh.wordpress.com/2014/02/17/carcinoid-tumors-of-the-gastrointestinal-tract)

ROJoson’s Medical Anecdotal Report

Date of Observation: September 1, 2017

A 24-year-old male underwent removal of appendix (appendectomy for appendicitis).

Intraoperative findings showed a pelvic appendix with bulbous dilatation at the distal end, inflamed with fibrins on the serosal surface.  There were two palpable appendicoliths, one within the bulbous portion and another one at the proximal end.

Here are pictures of the specimen:

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I was surprised when the histopathology result came in showing adenocarcinoma of the appendix.

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With the appendix completely removed (6 cm from the base) and 0.7 in its widest diameter, I recommended close monitoring and check-up.


ROJ@17oct22

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Thyroid patient saved from surgery – rabendan – 2017

Ms. R. Abendan, 68-year-old Filipina, consulted me in February 2017 for a second opinion.  She was advised a thyroid operation by another surgeon.

When I saw the patient, my impression was a multiple colloid adenomatous goiter.  I did a needle evaluation and aspiration biopsy and the latter showed consistent with colloid nodule.  I advised R. Abendan a trial of medical therapy.  The biggest thyroid mass was 4 cm in size.

I started with a low dose of levothyroxine and then gradually increase it to a higher dose.  In one month’s time (March 2017), the 4-cm mass shrunk to 1-2 cm.  I have been maintaining her on this medicine.

On October 2017 – she had a follow-up with me.  Clinically, there was only about 1-cm palpable nodule on the right side.  I am maintaining her on the levothyroxine.

The ultrasound done in June 2017 showed marked decrease in the sizes of the nodules from the largest of 4 cm to subcentimeters (less than one centimeter) on ultrasound.

Note the comparison of  the June 2017 ultrasound to the Deceomber 2016 ultrasound (prior to start of levothyroxine).

Note the decrease from 4 cm to subcentimeter (less than one centimeter) on ultrasound.

December 2016 ultrasound result:

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June 2017 ultrasound result:

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R. Abendan is one of the hundreds of thyroid patients whom I have saved from unnecessary thyroid surgery since 1985 when I started doing needle evaluation and aspiration biopsy of thyroid nodules in my clinic.



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ROJ@17oct22

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Thyroid patient saved from surgery -mdavid – 2016

Ms. M. David, 55-year-old Filipina, consulted me in late 2016 for a second opinion.  She was advised a thyroid operation by another surgeon.  Her son,  a medical student in the University of the Philippines College of Medicine, referred her to me.

When I saw the patient, my impression was a multiple colloid adenomatous goiter.  I did a needle evaluation and aspiration biopsy and the latter showed consistent with colloid nodule.  I advised M. David a trial of medical therapy.  The biggest thyroid mass was 3 cm in size.

I started with a low dose of levothyroxine and then gradually increase it to a higher dose.  In 6 months time, the masses decreased in size.  I have been maintaining her on this medicine.

October 21, 2017 – she had a follow-up with me.  The ultrasound result showed marked decrease in the sizes of the nodules.   Clinically, there were no longer palpable thyroid nodules.

Note the October 2017 ultrasound was compared to the March 2016 ultrasound (prior to start of levothyroxine).

Note the decrease from 2.7 cm and 2.5 cm to subcentimeters (less than one centimeter) on ultrasound.

 

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M. David is one of the hundreds of thyroid patients whom I have saved from unnecessary thyroid surgery since 1985 when I started doing needle evaluation and aspiration biopsy of thyroid nodules in my clinic.



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ROJ@17oct22

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Effect of Facebook and Blogs – 17oct20

There will be positive and negative effects of social media like Facebook and blogs.

There will be benefits and risks.

I have to accept these when I involve myself in social media.

Below is an example of a positive effect.

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ROJ@17oct22

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Tongue Cancer

58-year-old Filipino female with right-sided tongue cancer – squamous cell carcinoma.

Non-smoker.

Partial glossectomy (wide excision) and supraomohyoid neck dissection were done.

Before glossectomy –  2 to 2.5 cm mass.

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After glossectomy.

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Whole gross specimen after glossectomy.

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Cut-section of specimen.

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A nasogastric tube was placed to facilitate feeding.

Communication was facilitated through a portable white board.

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ROJ@17oct18

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Breast Cancer Survivor Maxima Bernardino – 18 Years in Remission

In 2013, I posted this already in my ROJoson’s Cancer Survivors Registry.

https://sites.google.com/site/rojosonscancersurvivors/breast-cancer-survivors-10-20-years-page1

At that time, I did not have a picture of Ms. Maxima Bernardino.  October 16, 2017, I was supplied a picture by the daughters who wanted it included in the registry.  The daughters support my advocacy.  They wanted their mother to serve as an inspiration of hope for other breast cancer patients.

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ROJ@17oct16

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