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:

abendan_1

 

June 2017 ultrasound result:

abendan_2

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.

 

mdavid_thyroid_17oct21

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.

filipinodoctor

 


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.

IMG_5951

After glossectomy.

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Whole gross specimen after glossectomy.

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Cut-section of specimen.

IMG_5959


A nasogastric tube was placed to facilitate feeding.

Communication was facilitated through a portable white board.

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IMG_5978


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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Ganglion cysts on the hand, wrist and thumb

3 different patients.


Ganglion cyst at the dorsum of the hand treated by needle aspiration.

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ganglion_cyst_vicky_02_october 11

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Recurrent ganglion cyst at the wrist joint treated by needle aspiration.

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Ganglion cyst (or mucus cyst) on the thumb treated by needle aspiration.

Preaspiration

ganglion_cyst_roj_17oct10 (1)

ganglion_cyst_roj_17oct10 (3)

Post-aspiration

ganglion_cyst_roj_17oct10 (4)

ganglion_cyst_roj_17oct10 (5)


 


Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jellylike fluid.

If your ganglion cyst is causing you problems, your doctor may suggest trying to drain the cyst with a needle. Removing the cyst surgically also is an option. But if you have no symptoms, no treatment is necessary. In many cases, the cysts go away on their own.

From Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/ganglion-cyst/symptoms-causes/syc-20351156



ROJoson’s Advices:

Recommendations: (Health-Process-Evidence-based Clinical Practice Guidelines on Treatment of Ganglion Cysts of Wrist)

  1. Option for observation, if ganglion cyst is small (about 1 cm), and patient refuses active treatment.   Spontaneous resolution in 58% of cases.
  2. Needle aspiration – initial active treatment, may be repeated if with recurrence.
  3. Needle aspiration with injection of substance – if with persistent recurrence, say 3 or more.
  4. Excision – if with persistent recurrence despite needle aspiration or if with persistent recurrence despite needle aspiration with injection of substance

Recommended reading:

https://rojosonmedicalclinic.wordpress.com/2016/05/07/management-of-a-patient-process-in-action-ganglion-cyst-of-the-wrist/


ROJ@17oct16

Posted in Ganglion Cysts | Leave a comment

History of my ganglion cyst on my right thumb

https://www.facebook.com/pg/ROJosonMedicalClinic/photos/?tab=album&album_id=673672092653843

Updated: 17oct16

See also:

https://rojosonmedicalclinic.wordpress.com/2012/04/10/follow-up-on-rojosons-ganglion-cyst-on-right-thumb-april-10-2012/

Posted in Ganglion Cysts | Leave a comment