March 2, 2010
Each year when I return from the mission trip, I am asked what kind of things did you see and what kind of surgeries did you do. This list is in response to those questions.
1. I saw 180 patients in consultation and of that we did surgery on around 120 total.
2. Two different children with developmental handicaps probably from birth. One was a 4 year old with a sebaceous cyst of the scalp. Not unusual in adults but not seen much in kids.
3. A child of 6-7 years with handicaps that prevent talking and he had trouble walking. His mother carried a towel at all times because of his salivation. She thought that maybe he was tongue tied and we could fix it. Unfortunately, not so. I saw her later sitting outside feeding him an ice cream cone and using the towel wipe his chin.
4. A 40 year old male with a 3-4 inch wound on his left cheek where he received a machete cut while he was working. It occurred a year ago and was never sutured or cared for. We revised the scar and made it look much better.
5. A 14 year old girl with a thyroglossal duct cyst showed up the last day after we had filled the schedule and couldn’t remove it.
6. Saw a lady with heavy menstrual bleeding that needed a hysterectomy. She was seen on Thursday and scheduled for the following Tuesday. We ordered a hemoglobin only to make sure she wasn’t’ too anemic. On Monday she came in and said she couldn’t get the test done because they only do Hemoglobin test on Wed at the lab. We checked and found out that was true, but they could do a CBC any day….
7. We received referrals for patients who needed surgery from local doctors, our current clinic providers, and from prior project providers who knew we would be coming. We also saw patients who just wanted a second opinion from the North American docs to see if it agreed with their local doc.
8. An 88 year old lady who had a massive ventral incisonal hernia that encompassed the entire abdominal wall. She was very frail and not a candidate due to her age and the extent of her condition.
9. Saw an OB patient for a second opinion because her local doc told her she would need to have a C Section because she had an inguinal hernia that happened to be asymptomatic.
10. A 3 year old boy was brought by his mother. He seemed to be normal except his legs were atrophied and he couldn’t walk. She wanted to know if I could remove the lump over his sacrum. When I checked, there was a scar over a 15 cm myelomeningocel that he had closed at birth. I said no.
11. Elderly male patient with a hernia that had a BP of 209/117. He was asymptomatic and used to take pills for his blood pressure but not now. Sent him to our clinic which was 10 kilometers away for treatment of his BP before considering a hernia repair
12. Young man came in with his mother with an ingrown toenail. He was very disrespectful to his mother. I couldn’t tell if it was that or if he was mentally retarded. That behavior was very unusual.
13. A 10 day old little girl with a large inflammatory mass on her left breast. It may have been an infected bug bite. She had already seen her doc the day before and given antibiotics (IV) and the parents were given the antibiotic but no syringe to give it with.
14. A 3 month old with a large umbilical hernia and a small inguinal hernia. We told his mother to bring him back next year to be evaluated for one or both hernias.
15. A 3 year old with small lesions all over his body. She wanted them cut out, but it was molluscum contagiosum which is a self limiting viral type of infection that will go away in 6 weeks to 3 months by itself.
16. I saw several recurrent lipomas that we had taken off in the past. Kind of unusual.
17. In the DR you can classify inguinal hernias as small that can only be found on detailed inguinal exam (turn your head and cough), medium ones that are obvious and easily seen. The last are the large ones that you can diagnose without the patient having to pull his trousers down. I saw an old man with what looked like a large hernia, till he pulled a standard flashlight out of his front pocket.
18. A lady came in to see if we could remove the sty that she had on her left eye lid for the last 9 months.
19. A young man in his 20’s came in for a hernia. Exam revealed enlarged inguinal lymph nodes not a hernia. Further exam revealed a late stage penile cancer.
20. Saw a lot of hand and feet problems, such as ganglion cysts of hand and feet as well as corns calluses’ and bunions.
21. A young lady with a breast mass present during pregnancy and continuing 1 month after quitting breast feeding. Probable mastitis.
22. A 10 year old who came in with a 4 in fluctuant mass on his scalp that began shortly after his hair cut that turned out to be an abscess. We take the cleanliness of our barbers for granted.
23. A man we did a hernia operation on came to the hospital in a brand new pair of tennis shoes. His mother came with him also his brother who was wearing only flip flops. When our patient went into surgery, his brother borrowed the new tennis shoes and took then out for a test walk only to return about an hour later, right as his brother was returning from surgery in time to change shoes.
24. We only had one near miss on a wrong site surgery. Classic example of multiple system failures. Fortunately, it was caught at the last step before surgery and corrected.
