Steve Trembley 2012 D.R.
I called my wife the other day, to just see what was new.
She also asked me how I was, and what was new here too.
I said “I‘m at the beach right now, and just had beans and rice,
And chicken, fish and pork chops, and it was very nice.
The water at the beach here is clean and warm and wet.
The sun is shining brightly, as good as it can get.
There is a nude beach down the way, (I think I heard her groan.)
And also Happy Birthday! I hate that you’re alone.
And now I’ll put my sunscreen on, and take a little nap”
Then all at once the phone went dead. I heard a little snap!
“Hello, hello,” I said to her. “Are you still there my dear?”
She said “I hit the phone real hard, to hurt your little ear.”
“Thank you for your input!” she said quite high and loud.
“I hope that you are happy, within your little crowd.”
It’s not so nice here. A limb fell from afar,
And knocked off several shingles, and then landed on the car.
The chickens have stopped laying eggs. The dog’s are out of food.
The cat has not been seen for days. Nothing here is good.
The mice are running rampant, invading all our stuff.
And squirrels are in the attic. I say “enough’s enough!”
The horses really miss you. I wave as I drive by.
But I think that they will be okay. I don’t think horses cry.
“Perhaps you’re just exaggerating”, I said. “I can’t believe it’s true.
With all the wildlife problems, it sounds more like a zoo.”
“The plumbing and the wiring”, she said, “have seen much better days.”
“The dishwasher is broken. I eat on plastic trays.”
“The washer and the dryer are shot. We’re even out of wood.
Nothing works around this house, exactly as it should.”
“It must be like the DR. I don’t know what to do.
Can you tell that I’m not happy? What was your initial clue?”
“I’m thinking of a new house and perhaps a car as well.
Mercedes makes some real nice ones. I love that new car smell.”
“I hope your work has gone real well, and you are glad that you have went.
But when you ever get back here home, your money will be spent.”
“So, please come home as soon as you can. I also miss you, too.
You’re needed here in Kansas. You have a lot to do.”
Tuesday, February 14, 2012
Thursday, February 9, 2012
Monte Plata Case Log 2012
General Surgery
Inguinal Herniorraphy 23
Hydrocoelectomy 8
Circumcision 6
Excision of Ganglion 6
Cholecystectomy 4
Epigastric Herniorraphy 4
Breast Biopsy 4
Hemorrhoidectomy 3
Excision of Anal Fistulae 1
Excision of Axillary Mass 1
Aspiration of Thyroid 1
Gynecologic
Hysterectomy 10
Tubal Ligation 10
Anterior Colporraphy 1
Posterior Colporraphy 1
Cervical Conization 1
C. Section 1
Major Surgery 73
Minor Surgery 47
Inguinal Herniorraphy 23
Hydrocoelectomy 8
Circumcision 6
Excision of Ganglion 6
Cholecystectomy 4
Epigastric Herniorraphy 4
Breast Biopsy 4
Hemorrhoidectomy 3
Excision of Anal Fistulae 1
Excision of Axillary Mass 1
Aspiration of Thyroid 1
Gynecologic
Hysterectomy 10
Tubal Ligation 10
Anterior Colporraphy 1
Posterior Colporraphy 1
Cervical Conization 1
C. Section 1
Major Surgery 73
Minor Surgery 47
Interesting Cases for 2012
Cases that didn’t go to the OR
1. 60 year old patient with foot pain that had brought an xray that showed a bone spur on his heal. No ortho instruments or fluoroscopy available.
2. Patient with fibrocystic breast changes. Surgery is not indicated.
3. Patient referred to us from the medical clinic… from last year for a hernia but he really didn’t have a hernia.
4. Patient with a large ventral hernia. Needed a large piece of mesh to repair, too big for us to repair but patient had seen Dr in city and would do surgery but patient had to provide her own mesh (over $1000), so we gave her the mesh for her surgery.
5. Parotid mass- Not able to do surgery with probable facial nerve involvement.
6. Patient with a kidney stone (brought her X-rays)
7. 2 patients with varicocoel of the scrotum… patient were handcuffed from the prison.
8. Patient came in 5’ 4’’ at 200 # and wanted us to take off the excess skin off her arms and thighs since she had lost weight. No we didn’t.
9. Patient with calluses on the bottom of his feet… who doesn’t have these.
10. Patient with burn scars from childhood and keloid.
11. 80 year old lady with a massive ventral incisional hernia for 5 years after a benign ovarian cyst removal. Told her it would require surgery to fix, she replied "heavens me, well I sure don’t want surgery", she then said thank you and gave me 7 eggs out of her purse.
12. Lots of patients with gynecological medical problems don’t ask for details.
13. Patient with prostate enlargement.
14. Patient with crooked toes.
15. Patient with recurrent neck mass found to be cancer last year.
16. Patient came in limping saying he had a hernia. When I asked where he pointed to his back and pulled out an MRI that showed a herniated disc. He said he already saw a neurosurgeon but he wants $200,000RD.
17. Patient wanted surgery to fix his hernia but still had a suprapubic catheter in place since his open prostatectomy
Patients that we did take to OR
1. Multiple patients with high BP as high as 250/150. No prior surgery or treatments. Sent to clinic and or local docs for treatment prior to surgery.
2. 13 year old with undescended testis.
3. Young patient with fibroadenoma. Was able to use a donated Sonosite ultrasound to diagnose.
4. Several patients with ganglion cyst of wrist… didn’t see any reoccurrences maybe since they don’t generally come back.
5. Keloid in multiple locations and patients. Did have steroids to inject to minimize reoccurrences. Patient would chance the reoccurrence for the possibility.
6. Had several patients come in with Preop clearance from cardiologist with ASA and AHA criterion listed. Great Preop workups.
7. Saw 4 patients with gallstones, only one didn’t have stones on ultrasound. Ultrasound quality is marginal at best.
8. Did 10 hysterectomies and 10 tubal ligations.
9. 4 year old child with hernia but at OR hernia couldn’t be found. Mom came back later to thank doc for fixing her son who was better after surgery.
10. First day only 6 minor surgeries due to delay in getting into town from airline cancellation.
11. One day did 3 family members surgeries and all had Postop laryngeal spasms. Maybe some type of environmental allergy or sensitivity.
12. Did one thyroid aspiration with the ultrasound guidance.
13. Had an average of 2-4 patients stay overnight each day except for the first Monday and last Wed. Made Preop and Postop very hectic early in the morning.
14. The open gallbladder surgery patient went home same day and the hysterectomy patients were discharged the following morning.
15. Did one post partum tubal ligation in a lady who had delivered in the night.
16. A 38 year old patient with a hysterectomy for bleeding was found at surgery to be likely due to cervical cancer.
17. Several rectal surgeries with a colorectal specialist in our group.
18. Several very large hydrocoels… some as large as soccer balls.
19. Seems like more adult large hernia patients than in years past.
20. Had a patient that wanted a tubal ligation surgery from us. She had previously been scheduled at another hospital but when she arrived late for surgery, she was told someone else had used her name and had the surgery already so she was turned away.. Identity theft in a 3rd world country.
1. 60 year old patient with foot pain that had brought an xray that showed a bone spur on his heal. No ortho instruments or fluoroscopy available.
2. Patient with fibrocystic breast changes. Surgery is not indicated.
3. Patient referred to us from the medical clinic… from last year for a hernia but he really didn’t have a hernia.
4. Patient with a large ventral hernia. Needed a large piece of mesh to repair, too big for us to repair but patient had seen Dr in city and would do surgery but patient had to provide her own mesh (over $1000), so we gave her the mesh for her surgery.
5. Parotid mass- Not able to do surgery with probable facial nerve involvement.
6. Patient with a kidney stone (brought her X-rays)
7. 2 patients with varicocoel of the scrotum… patient were handcuffed from the prison.
8. Patient came in 5’ 4’’ at 200 # and wanted us to take off the excess skin off her arms and thighs since she had lost weight. No we didn’t.
9. Patient with calluses on the bottom of his feet… who doesn’t have these.
10. Patient with burn scars from childhood and keloid.
11. 80 year old lady with a massive ventral incisional hernia for 5 years after a benign ovarian cyst removal. Told her it would require surgery to fix, she replied "heavens me, well I sure don’t want surgery", she then said thank you and gave me 7 eggs out of her purse.
12. Lots of patients with gynecological medical problems don’t ask for details.
13. Patient with prostate enlargement.
14. Patient with crooked toes.
15. Patient with recurrent neck mass found to be cancer last year.
16. Patient came in limping saying he had a hernia. When I asked where he pointed to his back and pulled out an MRI that showed a herniated disc. He said he already saw a neurosurgeon but he wants $200,000RD.
17. Patient wanted surgery to fix his hernia but still had a suprapubic catheter in place since his open prostatectomy
Patients that we did take to OR
1. Multiple patients with high BP as high as 250/150. No prior surgery or treatments. Sent to clinic and or local docs for treatment prior to surgery.
2. 13 year old with undescended testis.
3. Young patient with fibroadenoma. Was able to use a donated Sonosite ultrasound to diagnose.
4. Several patients with ganglion cyst of wrist… didn’t see any reoccurrences maybe since they don’t generally come back.
5. Keloid in multiple locations and patients. Did have steroids to inject to minimize reoccurrences. Patient would chance the reoccurrence for the possibility.
6. Had several patients come in with Preop clearance from cardiologist with ASA and AHA criterion listed. Great Preop workups.
7. Saw 4 patients with gallstones, only one didn’t have stones on ultrasound. Ultrasound quality is marginal at best.
8. Did 10 hysterectomies and 10 tubal ligations.
9. 4 year old child with hernia but at OR hernia couldn’t be found. Mom came back later to thank doc for fixing her son who was better after surgery.
10. First day only 6 minor surgeries due to delay in getting into town from airline cancellation.
11. One day did 3 family members surgeries and all had Postop laryngeal spasms. Maybe some type of environmental allergy or sensitivity.
12. Did one thyroid aspiration with the ultrasound guidance.
13. Had an average of 2-4 patients stay overnight each day except for the first Monday and last Wed. Made Preop and Postop very hectic early in the morning.
14. The open gallbladder surgery patient went home same day and the hysterectomy patients were discharged the following morning.
15. Did one post partum tubal ligation in a lady who had delivered in the night.
16. A 38 year old patient with a hysterectomy for bleeding was found at surgery to be likely due to cervical cancer.
17. Several rectal surgeries with a colorectal specialist in our group.
18. Several very large hydrocoels… some as large as soccer balls.
19. Seems like more adult large hernia patients than in years past.
20. Had a patient that wanted a tubal ligation surgery from us. She had previously been scheduled at another hospital but when she arrived late for surgery, she was told someone else had used her name and had the surgery already so she was turned away.. Identity theft in a 3rd world country.
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