As we approach the end of the year, I would like to take this opportunity to wish all our Christian readers ( yes all 3 of you!) a very Merry Christmas! and happy holidays and a happy new year to everyone too!
Here's wishing to an awesome 2011!
I took the time to record the caroling at the hospital lobby the other day, so here's the video after the jump. Sorry its a bit shaky, recorded on my 5MP Nokia.. enjoy!
- the BomohTulang -
Saturday, December 25, 2010
Saturday, December 18, 2010
GANGLION CYST - swelling in the wrist
Patients frequently present to the clinic with a lump at the wrist, with or without associated pain. These masses are usually round, smooth, and soft to firm with pressure.
The usual diagnosis would be a GANGLION CYST.
Ganglia cyst are among the most common cause of focal masses in the hand. They are thought to arise from the joint synovium or the sheaths of the tendons transversing the joint. The cause of the cysts remain unclear although it has been hypothesized that occupational trauma plays a part.
As described above, they usually do not cause pain, although when they get bigger, the cyst might press onto the structures around the wrist joint, such as an overlying nerve or tendon. They could also catch onto clothing or watch straps giving rise to discomfort. Lastly, they could just be a nuisance from a cosmetic point of view - in which case the patient usually request for excision.
Can you leave it alone?
Yes you can, and as I have explained, if they do not cause any pain, it really is a harmless swelling. In addition, if the swelling is small, there just might be a chance that the swelling would disappear.
However, some patients would insist that the lump be removed (for various reason - large swelling, pain, disfiguring, etc) in which case the options are:
Aspiration of the cyst.
This can be done as an office procedure. A local anaesthetic is usually administered around the lump and the lump aspirated with a large bore needle. Some practitioners would instil steroid into the remaining cavity to prevent recurrence. The success rate of this procedure is about 60%. (ie 1/3 of patients will have recurrence)
Surgical excision
The procedure of choice, in my opinion, as the success rate goes up to 90% (ie only 1 in 10 surgeries will have a recurrence). This can be done as a day procedure in the OT. Although some doctors can do it under local anaesthesia, the preferred method would be under general anaesthesia or a regional block at the minimum. The reason being that the root of the ganglion is usually deep seated and to get access to the deeper structures under local anaesthesia will cause much discomfort to the patient, not to mention unsettling to the operating surgeon.
Post surgery.
There might be some discomfort and swelling around the area operated. I usually close the skin with an absorbable suture so that no removal of the sutures need be done and it leaves a nicer scar.
Sometimes, with a larger lump, some ligaments of the wrist needs to be retracted and have to repaired. In this case, the patient will be required to use a resting wrist splint for a short period of time.
The usual diagnosis would be a GANGLION CYST.
As described above, they usually do not cause pain, although when they get bigger, the cyst might press onto the structures around the wrist joint, such as an overlying nerve or tendon. They could also catch onto clothing or watch straps giving rise to discomfort. Lastly, they could just be a nuisance from a cosmetic point of view - in which case the patient usually request for excision.
Can you leave it alone?
Yes you can, and as I have explained, if they do not cause any pain, it really is a harmless swelling. In addition, if the swelling is small, there just might be a chance that the swelling would disappear.
However, some patients would insist that the lump be removed (for various reason - large swelling, pain, disfiguring, etc) in which case the options are:
Aspiration of the cyst.
This can be done as an office procedure. A local anaesthetic is usually administered around the lump and the lump aspirated with a large bore needle. Some practitioners would instil steroid into the remaining cavity to prevent recurrence. The success rate of this procedure is about 60%. (ie 1/3 of patients will have recurrence)
Surgical excision
The procedure of choice, in my opinion, as the success rate goes up to 90% (ie only 1 in 10 surgeries will have a recurrence). This can be done as a day procedure in the OT. Although some doctors can do it under local anaesthesia, the preferred method would be under general anaesthesia or a regional block at the minimum. The reason being that the root of the ganglion is usually deep seated and to get access to the deeper structures under local anaesthesia will cause much discomfort to the patient, not to mention unsettling to the operating surgeon.
There might be some discomfort and swelling around the area operated. I usually close the skin with an absorbable suture so that no removal of the sutures need be done and it leaves a nicer scar.
Sometimes, with a larger lump, some ligaments of the wrist needs to be retracted and have to repaired. In this case, the patient will be required to use a resting wrist splint for a short period of time.
Sunday, December 12, 2010
STACK THEM UP - The Mallet finger splint
A finger has a mallet finger deformity when the distal phalanx droops down, with the patient unable to actively extend the joint.
It is also known as the baseball finger, in which the ball hits the distal phalanx and forcibly flexes the joint. This will usually result in an avulsion of the attachment of extensor tendon to the distal phalanx, usually accompanied with a flake of bone.
It can be an open (ie with a wound - in which case the tendon is cut) or closed (ie no wound - implying an avulsion injury) injury.
For closed injuries, the usual treatment is non-surgical. The patient will need to use a splint - a so-called STACK splint, to keep the joint in extension (or hyperextension even) so as to allow the avulsed flake of bone to heal and to prevent stretching of the tendon.
One needs to use the splint diligently for 6 to 8 weeks to allow adequate time for healing. There is a chance of relapse if the splint is taken out for an extended period of time. At the end of the treatment period, one might find that the finger may be stiff in which case physiotherapy might help.
- the BomohTulang -
It is also known as the baseball finger, in which the ball hits the distal phalanx and forcibly flexes the joint. This will usually result in an avulsion of the attachment of extensor tendon to the distal phalanx, usually accompanied with a flake of bone.
It can be an open (ie with a wound - in which case the tendon is cut) or closed (ie no wound - implying an avulsion injury) injury.
For closed injuries, the usual treatment is non-surgical. The patient will need to use a splint - a so-called STACK splint, to keep the joint in extension (or hyperextension even) so as to allow the avulsed flake of bone to heal and to prevent stretching of the tendon.
 |
| a custom made Stack splint made by the Occupational therapy dept |
 |
| another Stack splint. bought off the shelf. nice. |
One needs to use the splint diligently for 6 to 8 weeks to allow adequate time for healing. There is a chance of relapse if the splint is taken out for an extended period of time. At the end of the treatment period, one might find that the finger may be stiff in which case physiotherapy might help.
- the BomohTulang -
Monday, December 6, 2010
COLUMBIA ASIA HOSPITAL BUKIT RIMAU - Driving directions.
Im going to write a bit about the hospital today.
CAHBR was built on the premise of it being a neighborhood hospital, serving the needs of the surrounding community, namely Bukit Rimau and Kota Kemuning plus the adjacent areas.
It is a 84 bedded multidisciplinary specialist hospital, situated in the rapidly growing southern part of Shah Alam. Facilities include specialist clinics, wards, labour rooms, 3 operating theatres, ICU, 24 hour emergency room.
How does one get here? Easy.
For those coming from Subang Jaya / PJ /KL, the easiest way is to take the Shah Alam (Kesas) highway heading south / east towards Port Klang.
You need to take exit 505 Bukit Rimau, just before the Bukit Rimau toll.
As you enter Bukit Rimau, you will see a roundabout before you.. and that's it!
The hospital is right in front of you.
If you are staying in other parts of Shah Alam, say Sec 2, 3 7, etc : you can always take the LKSA highway all the way to Kota Kemuning, then as you encounter the 1st roundabout ( yes Shah Alam is full of them I know!) take a right turn to Bukit Rimau. The hospital should be about a kilometer away.
Okay here's a map courtesy of the website:
Here's another more interactive map, courtesy of uncle Google:
View Larger Map
More info? Webby below:
http://www.columbiaasia.com/bukit-rimau/
I'll be looking forward to meeting you!
- the BomohTulang -
CAHBR was built on the premise of it being a neighborhood hospital, serving the needs of the surrounding community, namely Bukit Rimau and Kota Kemuning plus the adjacent areas.
It is a 84 bedded multidisciplinary specialist hospital, situated in the rapidly growing southern part of Shah Alam. Facilities include specialist clinics, wards, labour rooms, 3 operating theatres, ICU, 24 hour emergency room.
How does one get here? Easy.
For those coming from Subang Jaya / PJ /KL, the easiest way is to take the Shah Alam (Kesas) highway heading south / east towards Port Klang.
You need to take exit 505 Bukit Rimau, just before the Bukit Rimau toll.
As you enter Bukit Rimau, you will see a roundabout before you.. and that's it!
The hospital is right in front of you.
If you are staying in other parts of Shah Alam, say Sec 2, 3 7, etc : you can always take the LKSA highway all the way to Kota Kemuning, then as you encounter the 1st roundabout ( yes Shah Alam is full of them I know!) take a right turn to Bukit Rimau. The hospital should be about a kilometer away.
Okay here's a map courtesy of the website:
Here's another more interactive map, courtesy of uncle Google:
View Larger Map
More info? Webby below:
http://www.columbiaasia.com/bukit-rimau/
I'll be looking forward to meeting you!
- the BomohTulang -
Tuesday, November 16, 2010
Salam Eid-ul Adha
Eid ul adha ( or - especially for old school people like me heheh - known as Hari Raya Haji in Malaysia or Singapore ) commemorates the willingness of Prophet Abraham to sacrifice his son Ismail in the name of god. God however substituted an animal in the place of Abraham's son. Eid ul Adha loosely translates into the "feast of sacrifice", which, in Malaysia gives us the other name for this Festival - Hari Raya Qurban - a day where muslims reenacts Abraham's act of obedience by sacrificing a cow or goat.
For Muslims in Malaysia, it is one of the major celebrations, the other being Eid ul Fitri ( Hari Raya Puasa). It also signifies the day when the Haj pilgrims complete the haj ritual in Mecca - hence the other name Hari Raya Haji.
Righto, enough of the history lesson. On a more personal note, this raya is more significant for my family as this year my mother in law ( yes don't we all love them!) joins the estimated 3 million pilgrims to the holy land for her Haj pilgrimage. May her journey be blessed and we pray for her safe return.
For Muslims in Malaysia, it is one of the major celebrations, the other being Eid ul Fitri ( Hari Raya Puasa). It also signifies the day when the Haj pilgrims complete the haj ritual in Mecca - hence the other name Hari Raya Haji.
Righto, enough of the history lesson. On a more personal note, this raya is more significant for my family as this year my mother in law ( yes don't we all love them!) joins the estimated 3 million pilgrims to the holy land for her Haj pilgrimage. May her journey be blessed and we pray for her safe return.
- the BomohTulang -
Forearm - Single bone fracture
As I explained in the previous post, we had to operate on the patient with a forearm fracture.
Basically what she had was a fracture of the distal 1/3 of the radius with a concomitant dislocation of the distal radio-ulnar joint (the so-called "Galleazi Fracture" - medical students, take note :) )
Can we treat this non-surgically? I mean people have been treating fractures of the forearm with splints and POP for years right? Well with the advent of modern orthopedic management, that line of treatment has been largely abandoned.
We know that with this fracture, a treatment regimen consisting of closed reduction and cast immobilization has a high rate of unsatisfactory results. Patients will have problems with malunion, pain at the distal radio-ulnar joint, and worse still pronation and supination of the forearm will be severely compromised.
Therefore open reduction of the radial shaft fracture and internal fixation with dynamic compression plate is the treatment of choice in adults. Rigid anatomical fixation of the radial shaft fracture generally reduces the distal radioulnar joint dislocation.
Ladies and Gentlemen, I now present to you the post op x rays:
Tadaa! As you can see, the fractured bone has been aligned in place and the distal radio-ulnar joint is reduced.
Patient went back to work at 6 weeks.. as a GP (!)
- the BomohTulang -
Basically what she had was a fracture of the distal 1/3 of the radius with a concomitant dislocation of the distal radio-ulnar joint (the so-called "Galleazi Fracture" - medical students, take note :) )
Can we treat this non-surgically? I mean people have been treating fractures of the forearm with splints and POP for years right? Well with the advent of modern orthopedic management, that line of treatment has been largely abandoned.
We know that with this fracture, a treatment regimen consisting of closed reduction and cast immobilization has a high rate of unsatisfactory results. Patients will have problems with malunion, pain at the distal radio-ulnar joint, and worse still pronation and supination of the forearm will be severely compromised.
Therefore open reduction of the radial shaft fracture and internal fixation with dynamic compression plate is the treatment of choice in adults. Rigid anatomical fixation of the radial shaft fracture generally reduces the distal radioulnar joint dislocation.
Ladies and Gentlemen, I now present to you the post op x rays:
Tadaa! As you can see, the fractured bone has been aligned in place and the distal radio-ulnar joint is reduced.
Patient went back to work at 6 weeks.. as a GP (!)
- the BomohTulang -
Sunday, November 7, 2010
First surgery!
We had our first surgery in our brand new centre the other day, the 3rd day of business.
(well technically I wasn't the first lah, but it was the first Orthopedic case, so that counts right? :P)Our patient, a 52 year old lady came in to the ER with a broken forearm, after her car skidded somewhere in Kota Kemuning. No other injuries fortunately, so it was a relatively straightforward surgery.
That's the exterior view of Columbia Asia Hospital Bukit Rimau, btw
In the OT
Posing for the camera.. ( err yes I do work sometimes)
.. and presenting to you Dr Paul the anaesthetist in the background..
With the OT staff.. hoping to get busier soon!
- the BomohTulang -
- the BomohTulang -
Thursday, November 4, 2010
CAHBR open day
Columbia Asia Hospital Bukit Rimau.
Yes thats what those letters stand for, and thats where I practice currently, after having served the government for the past 18 years.. time to move on I guess.
Err okay, moving on ( pun intended) the hospital had an open day on the Saturday 23rd October, prior to starting business the following Monday. I guess its sort of like introducing the hospital to the surrounding community, making them aware of the facilities available.
Sorry not many pictures available, was too busy meeting and greetingpotential clients err patients.. :)
Anyways, here's the address for the hospital. It's in Bukit Rimau (duh!) Shah Alam. We are located adjacent to Kota Kemuning and easily accessible from the Shah Alam (Kesas) Highway.
Appointments? phone number below. You know what to do..
Yes thats what those letters stand for, and thats where I practice currently, after having served the government for the past 18 years.. time to move on I guess.
Err okay, moving on ( pun intended) the hospital had an open day on the Saturday 23rd October, prior to starting business the following Monday. I guess its sort of like introducing the hospital to the surrounding community, making them aware of the facilities available.
Sorry not many pictures available, was too busy meeting and greeting
My clinic. Anybody wants to open a florist shop?
The waiting lounge. View from outside my clinic
The cafeteria
Appointments? phone number below. You know what to do..
Columbia Asia Hospital - Bukit Rimau
No3, Persiaran Anggerik Eria, Bukit Rimau, Seksyen 32
40460 Shah Alam, Selangor Darul Ehsan
Tel: 603-51259999 Fax: 603-51259998
.. And Fatin here will answer your calls..
- the BomohTulang -
- the BomohTulang -
Monday, November 1, 2010
Welcome to the blog
Hi. I know, this is the first post, so it feels a bit awkward. Its just that I thought that it would be nice to start a blog here, in connection with the website, so that I could update some information and share some interesting cases that I encounter during my daily dealings in my centre.
Thanks for dropping by, and I do hope that you could leave some comments after reading my blog.
Thanks for dropping by, and I do hope that you could leave some comments after reading my blog.
- the BomohTulang -
Subscribe to:
Posts (Atom)