VALLAM PHC:

                      Hey bloggers. my posting now is Vallam PHC. After working for around 8 days what i realised is how important is this set up for the well being of the people. a large mass of people come here to PHC mainly for geeting their routine HYPERTENSION , DIABETES , ANTENATAL CARE. just think if this bundle is diverted to the medical coolleges then there would have been utter confusion AND MORE IMPORTANTLY THE IMPORTANT CASES WILL BE MISSED. THIS WOULD HAVE BEEN DISASTER.  you know there is NO CURRENT EVEN FOR 3 TO 4 HOURS AND ALL THIS IS CARRIED OUT AD MIST SO MUCH SWEATING. LEVEL OF DEDICATION IS FAR FAR MORE

     But i see the other part of it where the drugs are under supplied added by the reduced level of health care workers leading to the STATE OF COMPENSATION OF THE LEVEL OF HEALTH CARE WHICH WOULD NOT BE HEALTHY. 

     THERE ARE WONDERFUL RECORD MAINTAINED AND I HEARD THERE ARE CHECKED ROUNTINELY.

THE BEST PART OF IT WOULD BE A NICE JOURNEY FROM PHC TO HOSTEL IN MY BIKE WITH PRAKASH  CELL PHONE PLAYING A SONG FROM DIL WALE DUNIA LE JAYENGE

TRAUMA:

                have you ever thought of this. Some one so close to you goes out telling "kanna by bye na poituvaren". they go out of the home taking 2 wheeler and after some 52 minute the incoming call comes from the loved one. you being happy and takes the phone. BUT YOU HEAR THE VOICE OF SOMEONE ELSE TELLING WE ARE CALLING FROM SO AND SO PLACE. "entha phone ku sonthamanavara oru car eppa than addichu thuki potuchu. unga number inbox la erunthuchu athn kuppitom. naanga 108 la ethi GH ku annupi vachirukom... neenga sikkaramn vaanthu pathukonga.."

INCIDENTS LIKE THIS DO HAPPEN... FRIENDS LIFE IS SHORT DO LOVE AND RESPECT YOUR LOVED ONES BEFORE FATE TAKES THEM AWAY FROM US......

AND ITS THE DUTY OF DOCTORS TO SAVE THE PATIENTS WHO COME TO US CAUSE EVERY ONE HAS A LOVED ONE...........

                                                                   BY TRAUMA CARE SURGEON ASPIRANT

THE ATTITUDE WHICH NEEDS TO BE CHANGED:

Why is there much PRIDE AND PREJUDICE in our profession alone . the reason might be what which i felt in my mind was in other profession though they are highly paid they come under the control of some BIG PERSON LIKE THE CEO IN CORPORATE IT SECTOR FIELD , SENIOR MANAGER IN ADMINISTRATION FIELD . But as THE DOCTORS can do Private practice and be on our own feet many DOCTORS take it as the sole reason for being in more PRIDE NOT RESPECTING OTHERS. You can ask even business man are standing alone but why they are not like some doctors very pride cause they are dependent on the customers but in OUR CASE THE COSTUMER (THE PATIENTS) ARE DEPENDENT ON US. 

 THIS IS NOT THE RIGHT ATTITUDE FOR THE HEALTHY SOCIETY. ITS TIME FOR SOME DOCTORS TO CHANGE...

UNDERGROUND WORLD:

                 After going to the ART what i realized is there is lot of works which are happening in the underworld like HOMO SEX AND MANY PROSTITUTION. I even had the chance of speaking to one of the homo sex who told how he will draw in others towards that. THE DESCRIPTION OF IT WOULD NOT BE HEALTHY IN A PUBLIC FORUM. but i want to warn you in that BE CAREFUL AND DONT  EASILY TRAP INTO THESE ACTIVITIES CAUSE THE DEMON MAY BE NEXT TO YOU.

But i want to add a not that I TOO REALIZED THAT NOT ALL HIV COMMITTED PERSON GO IN FOR ALL this and in some cases even this works get justified like they don't have any source of income or their husbands return in for EVERY 5 YEARS(THINK OF THE SITUATION OF THE WIFE IN THIS CASE)or the WIFE GETS MARRIED TO THE HUSBAND WHO ALREADY HAS CONTRACTED DISEASE. 

i also see a better society building up like the brother who is non reactive has come for collecting the drugs for his sister as she has exams

I WANT TO END WITH A NOTE THAT I AM WELL AWARE THERE ARE OTHER MODE. thanks for reading. wish you happy life.

WHAT MISTAKE DID THE SMALL GIRL DO:

       My week went on with ART POSTINGS (POSTING RELATED TO AIDS) i had the chance to see varied number of patients.ONE OF THE GIRL WHO CAME BROUGHT ME TEARS. the girl is studying 1st standard and absolutely i am telling no one would ever suspect that girl to have this deadly disease. HER BOTH PARENTS HAD AIDS AND SHE IS A ORPHAN. She is on AIDS THERAPY RIGHT FROM BIRTH and you all know that the drugs itself has so many side effects. Her grandma is taking care of her.

I PUT ON SOME QUESTION??? DOES THE GIRL HAS ANY FUTURE OF SMILE? CAN SHE BE MARRIED?

similar to this girl many CHILDREN COME TO ART CENTER FOR THE MISTAKE DONE BY THE PARENTS...


THIS IS NOT THE GIRLS PHOTO. THIS IS FROM flickr.com

TRACHOESTOMY:

                            Had chance to see 2 tracheostomy in SICU today and yesterday. it was quite thrill to keep the knife on the patients neck with just a local anesthetic. and the second one even went for the most popular complication of any procedure HEMORRHAGE. PG sir just tried to hold and compress it with sponge which being futile he used a artery forceps to hold it from bleeding . The steps are given fine in BAILEY AND LOVE. hope that i keep a hand soon in one patients knife. By the way SICU was very daring with frequent emergency and accident cases with so much bleeding with most penultimate cases referred as the last chance of savior.

 DEAD MAN ALIVE:(FICTION)

                                Have we ever be afraid of something???


 ok the situation is like this I treat a patient in our ward. the patient has some hemoptysis problem. on examining he was diagnosed as have pulmonary tuberculosis. which was confirmed by sputum AFB and chest x ray. I was treating it according to routine. suddenly 2 days later I come in the morning to realize that the man has died. The  nurse on inquiring told that he coughed so much blood last night and he went for shock and died. THE NURSE SAID THAT LAST NIGHT SHE TRIED SO MUCH TO CATCH ME ON PHONE BUT COULD NOT GET. THE MAN BODY HAS ALREADY BE SENT FOR POSTMORTEM... ok i felt bad then thought ok its just happened. went to OP sat  for seeing patients. AROUND 11 55AM ONE PATIENT CAME I DID NOT SEE HIS FACE BUT WAS BUSY WRITING THE OP SEAT. HE TOLD HIS NAME AND SAID HE HAD COMPLIANT OF BLOOD ON COUGHING(HEMOPTYSIS). i raised and was shocked to see the man in ward .
 WHAT WILL YOU DO.  
                        TREAT HIM?SHOUT LOUD?FAINT AWAY?

         

COLLECTOR HAND SHAKE DAY 8:

                                                 today around evening i was called by Mathews to go to the blood bank where there was some  work. OK me too went. over there i realized it was not work but a felicitation function.. It was  well organized where the collector, the S.P. Tanjore ,The Dean ,The M.S and many respected dignitaries came. the function started with tamil thai vazhthu. Many talked about the importance of blood donating and the value behind it. I WENT AND COLLECTED THE AWARD REP TANJORE MEDICAL COLLEGE STUDENTS. THE BIGGEST PART WHICH I FELT HAPPY WAS WHEN I HAND SHAKED THE COLLECTOR. HIS SPEECH WAS VERY CATCHY. WE SHOULD ALSO SPEAK LIKE HIM. this day i will cherish in my life and i will aspire to do more work.THANK YOU FRIENDS ALL CREDITS FOR MY HAPPINESS GOES TO YOU. YOU ONLY DONATED BLOOD. THANK YOU. LETS DONATE FURTHER MORE. ITS TIME TO PUSH FORWARD

i will upload the photo once i get it.

DAY 7  the old fascinating story

                              From today on the duty is transferred to the TMCH OP. Today one girl came of age around 19 she was tall. Her complaint was that the second toe on her foot was growing it was awesome to see some one with only one toe alone so long and big and other toe are of normal size. she was advised to take an xray which showed that her bone part was fine. it is a soft tissue overgrowth of a particular digit on a unilateral side.differential diagnosis needs to be read???

 ok have i ever told what we do in  my prime objective posting FEVER SURVEILLANCE. it as that we calculate the number of 4 different cases FEVER, RTI,PUO,DOG BITE in TMCH OP,WARD,IMCU,CAUSALITY . then we have to enter the number of males and females among these and then make more and more cracky calculation which will make us go nuts. Then we have to fill alll this in the EDSIS form and then report to the SPM department.

 THE DAY WHEN SOME DECISION MATTERS:(the story)

                                This is one of the the fascinating true story which occurred in my life. one day in final year around evening there was a news in hostel that there was a accident in tanjore in  which there was huge number of injured people so they need some final year. so i went owing that i was free at that time. i went to ET WARD and thay gave me work of taking the blood from blood bank for transfer as many lost blood. I COULD SEE PEOPLE ON BED HAVING LOST THEIR LIMBS AND HANDS. in that i saw a boy who was seen as well read. on enquiring i came to know that he was from one of respectable colleges in Tanjore he is studying engineering. THE ATTENDING ORTHOPADECIAN SAID THAT THE BOY ARM  HAS TO BE REMOVED OWING TO THA AMOUNT OF INJURY HE HAD. THIS WAS THE OPTION ACCORDING TO OUR HOSPITAL PROTOCAL WHERE THE PRIORITY WAS GIVEN TO SAVING PATIENTS LIFE. WAS THE ARM REMOVED????? I WILL TELL IN NEXT BLOG....

AIN HUM:

                Today in OP a peculiar case came which has a incidence of 0.015 to 2 %of population.ITS AINHUM WHICH IS AUTO AMPUTATION OF THE LITTLE TOE BY A CONSTRICTING BAND WHERE THE cause could been due too anomalous posterior tibial artery blood supply.

TREATMENT: 

Incisions across the groove turned out to be ineffective. Excision of the groove followed by z-plasty could relieve pain and prevent autoamputation in Grade I and Grade II lesions. Grade III lesions are treated with disarticulating the metatarsophalangeal joint. This also relieves pain, and all patients have a useful and stable foot. Intralesional injection of corticosteroids is also helpful.

REF: THE WIKI( http://en.wikipedia.org/wiki/Ainhum)

MYSTERIOUS WOMEN DAY 5 AND 6:

                                             Hi as the op went on yesterday suddenly a women came she was well built she was continuously talking and in fact repeating the same words her words were something like"kaliatha magamai vesham kaduchuruchu ...ayyappan solitaru..."she was also continuously wiping the hands in front of her face. THE BIGGEST PART WHICH MADE ME ASTONISHED WAS SHE WAS INSTRUCTING ME TO WRIT THE MEDICINE SHE TELLS  ME TO WRITE. I WAS TAKEN ABACK. i prescribed some placebo in her good will.

   Next one women came she was crying. SHE TOLD THAT HER HUSBAND  HIT HER ON HER HEAD. WHAT IS THIS PEOPLE. still incidents like this happen in our country husband beating wife. they don't realize that wife's are their better half. I REJECTED TO TREAT HER AS SHE HAD A PERIOD OF UNCONSCIOUSNESS FOLLOWING ASSAULT. and who knows it might be a case of HEMATOMA IN BRAIN WHICH MANIFEST AFTER 2 DAYS.so i referred her to causality writing as assault.

     Today morning it would have been just 10 min from the start of OP a lady came with severe chest pain and sweating complaint she was near fainting. so i decided to take a ECG just as a formality. YOU KNOW I WAS SHOCKED WHEN I NOTICED A ST ELEVATION(SIGNIFICANT OF ISCHEMIA) . A 37 year old lady who come to OP this kind is alarming for us to be more careful. Any way i am aware that there are differential diagnosis for the elevation of ST SEGMENT... 108 was called and the lady was transferred in stretcher to the TMCH

WAS THE BOY IN CRISIS DAY 4:

                           Today a brand new day. being Monday we expected maximum crowd in the O.P.as we were seeing at the patients many patients came with the complaint of cough with cold and fever. One boy came around 9 am and he was crying. on enquiry he said that the hand has been hit in the wall and hand is swollen . On examination we found that the 3rd metacarpophalengeal joint is swollen in the dorsal aspect. so what is the big thing in the case is that THE BOY HAD 10TH PUBLIC EXAM IN JUST 60 MINUTES FROM THE TIME HE CAME TO OUR OP. so we decided to take immediate action considering the urgency of the situation. one of his Tamil teacher came with him to accompany and he was complaining that the boy had got the swelling while fighting with the other boy. i decided to take him to the pediatric OP though he was 15 years . in the Pedia OP one sir said to give him diclo and asked him to write exam. i was expecting some topical pain re liefer.

MY QUESTION WAS?? WAS THE BOY MALINGERING IN FEAR OF EXAM?? WAS HIS INJURY SELF INDUCED??My answer would be though there might be a chance of malingering it is better that we consider this kind of cases where something damn important for the patient(in this case the 10th board), its better to consider the case genuine and treat it with 200% .CAUSE THERE MIGHT BE A GENUINE CASE WHO MIGHT NEED OUR LOVE. WHO KNOWS THIS TIMELY HELP COULD HAVE SAVED THE BOYS FUTURE!!!

day 3 
PACEMAKER MAN INJECTION DAY:

                                     Hi bloggu people OK i went to the OP. then as i was seeing the cases there came a man with two of his children. he was complaining of giddiness. on further enquiry he told that he had been placed a pacemaker in his heart. for the first time i saw a pacemaker in position it was fascinating to see. then i further referred him to the medicine OP as the case might be bit complicated. Then after 11 am i decided to learn putting injection went to the RMH casuality and then i was seeing how to put TT INTRAMUSCULAR  and RABIES 2 SITE INTRADERMAL injection. the nurse was putting great then after that i decided its time to move on then i started putting injection.

HEY I HEARD ONE REAL STORY FROM ONE RUSSIAN SENIOR HE TOLD THAT WHEN HE WAS IN SURGERY DEPT he saw a case in which there ws gangrene all over the limb THE REASON WAS WRONG ADMINISTRATION OF PARACETAMOL INJECTION IN THE INTRAVENOUS WHILE PUTTING IN THE GLUTEAL REGION RATHER THAN INTRAMUSCULAR. SO BE CAREFUL WHILE PUTTING INJECTION . BE DOUBLY SURE BY WITHDRAWING AND SEEING FOR AIR