Life Is A Gamble

G.T., a 24 year old male was referred to me because of fever, rashes and decreased platelet count. His initial platelet was 76. In the management of decreased platelet like in dengue, transfusion of platelet is warranted if the platelet count is 50 or less or if there is a sign of bleeding... epistaxis, gum bleeding, tarry stools... The reason for the delay is that a rising platelet count is the gauge if the patient is already recovering from the disease.

When the patient’s platelet was already 58, the attending physician requested 3 units of platelet concentrate as standby. However the blood was not immediately available. Platelet went down to 50 and I ordered the transfusion at once. But they haven’t secured even a unit.

When we were informed that 3 units are available in another hospital, the latest platelet was already 62. I was faced with a decision whether or not to go on with the transfusion. The next platelet was 63, so I proceeded. A unit of platelet concentrate will increase the count by 10. With 3 units, I expect his platelet to rise by 30 or to 93 starting with 63. But later platelet counts after the transfusion were 67, 74, 78 and 84. This means probably that his count further decreased even after transfusion.

I compare this decision like playing black jack. When your card total is around 18 to 20, you can hit for another card. But there is a chance that you can go over 21. If I had not proceeded with the transfusion, I could have compromised the life of my patient.

Going Home

I have given the order to discharge patient P.R. (see Stubborn Mother). He has less phlegm and breathing without oxygen. He was very happy to go home. I attended a meeting. After about 3 hours, the resident physician called because P.R. arrested. His heart rate is zero, blood pressure is zero and no breathing. CPR was futile. I considered that he aspirated.

He is now going home. Not to their earthly home but in the home of our Father. Home... where he will be always happy... no physical deformities... no mental deficiencies. He will be forever with our Fathers arms.

Stubborn Mother

I admitted P.R. last Sunday, August 30, a 24 year old male with cerebral palsy. He looks like a 7 year old boy with severe malformed body. I diagnosed him to have pneumonia.

They want to stay for 24 hours only.

Aside from the challenge that I have to compute for the medicines to give, his mother refused the antibiotic, antipyretic and ferrous sulphate because he has history of allergy. For a patient who has pneumonia, I’m only giving inhaled bronchodilators.

The mother did not sign the Home Against Medical Advice form. No other medication was given until today, September 2, when his father arrived. Now I am giving the proper management.

Almost 3 days were wasted. If I was able to treat him properly at the start, he could be home by now or tomorrow.

Cases Come In Pairs

I was called to see patient C.N. to have tonic-clonic seizures. My primary consideration was that the seizure is due to hypoglacemia and alcohol. A day prior, he had a drinking spree and the following morning he was not able to eat because of abdominal pain and vomiting. He was then seen to have tonic-clonic convulsions. At the wards, he had no episodes of seizures. The laboratory exams done were all normal except for the low potassium.

At my clinic, I saw patient M.C. who had twitching of the right arm. The patient was able to tell what happened to her. And laboratory results were all normal.

Initially, I thought both are cases of seizure disorder, but they turned to be not. Cases may come in pairs, sometimes in threes. Worst, there were times that I have two mortalities few days apart. I hate those days.

Apostolate

I went to Antipolo General Hospital to get my professional fee for patient M.E. She has not gone home yet after I discharge her 3 weeks ago. Reason: she has no money. This is not the first time it happened in this hospital or in any other hospital I am affiliated. Worst, the hospital may ask her just to pay only the hospital bills and leave me with a promissory note. This is not the first time it happened to me either. I have a lot of promissory notes. This is part of my apostolate.

Complicated Pregnancy

E. K. is a 41 year old female admitted for headache and numbness of the whole body. She was admitted in May for palpitation and in June for weakness of the right side of the body. This case looks simple but what complicates my management is the fact she is 7 months pregnant.

In May, good that her obstetrician-gynecologist allowed be to give Amiodarone 200 mg capsules BID which reverted her cardiac rhythm to normal at once. In June, only Vitamin B complex was given which offered relief. I think that all these signs and symptoms are due to hormonal changes of pregnancy.

This admission, she is being treated for pre-eclampsia (hypertension with pregnancy) with Methyldopa 250 mg tablet TID.

Start of the Filipino Physician OnLine

     Hi! I am Dr. Dindo Ferdinand C. Santos, an Internist and a Family Physician, practicing medicine in the Philippines. I am the Filipino Physician OnLine. 

The PHYSICIAN 
     I am a graduate of University of the East Ramon Magsaysay Memorial Medical Center (1988). I finished my residency training in Internal Medicine in 1995 and had my certification in Family Medicine in 2003. Internal Medicine deals with the medical treatment of adults while Family Medicine deals with general practice. So, I can treat both adults and children that don't need surgery. 

The WEBSITE DESIGNER 
     I started web designing in 1995 with my own personal website. I am the webmaster of my club, the Rotary Club of Marikina, 2001 to 2005 and 2007-2010; and our district, Rotary International District 3800, from 2001 to 2008 and 2009 to 2010. 

     When I started my personal website entitled Filipino Internist on the Internet, I had the topic “The Doctor Is In” where my visitors can ask medical question via email. One case that I will never forget was a teenager in the US whose parents went on a vacation. She had continuous abdominal pain. She could have waited for her parents but I advised her to go to the emergency room immediately. Her sister brought her and true enough she was diagnosed to have appendicitis. If she had waited, her appendix could have ruptured. 

     If you have some medical queries, you can email me. I will answer them to the best of my ability. But please remember, there is no substitute to a consultation with your physician.