electives day 5, 6, 7

been lazy :P

day 5 - back to cardiology, saw a coronary angiogram.

day 6 - gastroenterologist

observed several endoscopy and one colonoscopy.
endoscopic procedure requires "conscious sedation" where the patient is put into a mild sedative state where s/he feels drowsy, perhaps drowsy enough to not remember the discomfort of the procedure.
Indication for procedure; e.g.
positive urea breath test - need to ascertain H.pylori damage if any, and visualise damage.
history of dyspepsia - looking for any possible cause
history of haematemesis
history and follow-up of GERD

diseases observed -

• GERD
• Oesophagal candida
• Barett's
• Diverticula disease
• Pancreatic Cancer
• Hepatitis B
• Hepatitis C
• piles
• acute food poisoning

things of notice-

• gasteroenterologist shows the actual video of endoscope to patients and extensively explain.
• GI diseases can be very non-specific, needs extensive use of investigations e.g. endoscopy, colonoscopy, radiology, ERCP etc etc
• Nocturnal pain is usually organic, and it is often an indication of something serious
• some medical institutions move onto H.Pylori eradication with only blood test result of H.Pylori IGG antigen positive. this is not necassarily advisable as IGG only measures long-term immunity to H.Pylori - if they repeatedly give you medications saying your IGG still up - they may be conning you.
• Danger of Haemmoroids - piles itself is relatively harmless. however, it can mask other serious disease as frank blood in stool will be common in patients with piles, and blood in stool is often an indication of malignancy
• measures that could be used to prevent GERD - small, frequent meals, no late night meals.
• Malaysia has a wide variety of alternative medicine avaliable - which means patients may be getting alternative therapy. ask about those, as they can affect patient's status. e.g. some chinese medicine may contain steroids.
• polyps are very common. it is often resected during Endoscopy

day 7 - rheumatologist + cardiologist

Diseases observed;

• Osteoarthritis - herbeden's sign
• osteopenia
• rheumatic arthritis
• Psoatic arthritis
• cervical spondylosis
• shingles (post renal-transplant)
• Varicose veins
• ST-depression (possibly CAD)
• Atrial Fib due to Thyrotoxicosis

Things of notice

• doctor may be able to help patients who wishes to go for a holiday overseas by writing a written statement of his/her conditions, medications etc. so that in any situation whereby s/he falls ill, the doctors in respective countries will know what to do.
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