December 29th, 2014

´╗┐Friday started again with Surgery in the morning then out patients in the afternoon. The surgery was just the removal of a tumor from the neck, how ever I did not stay for it as I was not feeling great. The out patients was not as good as the previous day, I was with my actual mentor this time, working in the snoring clinic. The only thing she told me was the patients were obese and that was why they snored so they needed to loose weight. She then told me she was too busy to explain any more to me so I went and found some of the med students who explained how in the snoring unit they monitored peoples sleep cycle and watched for their breathing rate, and heart rate. The students English was not great so it was quite difficult to follow along with what he was saying, but afterwards I just talked with another student about random things until the clinic closed.

Lady Boy

December 29th, 2014

Thursday December 18th,
My partner Brittany is still sick, so again I went to placment alone. This morning I did not go to the OR but instead went to out paitent, in the ear ward. It was alot of fun and more hands on than I thoughtit would be. The doctor explained everything to me, from how the charts worked, how the medications were prescribed, the type of governmet suport each paitent gets and how to tell. For each paitent who came in the doctor had me look in their ears and watch the ear drum move when air was puffed at it. Unlike in the US where we use the headphones to check hearing of each ear, here they still use the tuning fork, she had me try doing the test to a paitent but i could not get the tunning fork to resonate. All of the paitents were great and really paitent as the doctor worked with me. Four of the paitents we saw had meniere disease, a dissorder of the inner ear that causes vertigo, a ringing sound, and hearingloss, it most often effects one side or the other, less commonly both sides. The disease was inactive in three of thoes paitents and active in one, this is determined by looking at the hearing loss, if it drastically change, more than 5 points, since the last check then it is considered active. An older man then came in who had hearing loss from fluid being trapped in his middle ear, there was a blue draining tube in his left ear which the Doctor had me locate and describe. Our last paitent left me a bit counfused, both the doctor and nurse were women, and the paitent was a monk. It is against the rules of a monk for them to have any physical contact with women, so I was not really sure how everything would go, but it turns out that they can be in contact with women if its in a medical situation such as a doctors visit. The monk complained of a spinning sensation when he sat up or rolled over, the doctor preformed a test where she had him sit up, fall back, and go from one side to onother very quickly while controling his head, the results of the test showed that the symptoms had subsided to a degree, the doctor said it was most likely another case of inctive meniere disease. I greatly enjoyed going to the out paitent department.
The afternoon was again spent in the OR watching more nasal palups being removed.
Every thursday night we go out to the night market, and this being our first time there we all went to the lady boy show, now i’ll not go into detail but that was definantly quit the experience, very fun, especially since Gai makes all the guys sit up front. It was well worth the 80 Baht.

Doctor La

December 23rd, 2014

Wednesday December 17,
Today I worked alone as my partner Brittany is sick. My day was spent in the OR once again but today turned out to be much better than the previous days. I was suposed to see my mentor, as she was the one preforming the surgery,the removal of a tumor in the lower right cheek, but I did not see her or talk to her at all. I arrived near the end of the surgery, when a second surgon came in to finish the extraction, this is the surgon who made the day great. His name was Dr La, after asking who I was and explaining the case to me he treated me to some coffee (Thai coffee is very different, most drinks are iced, and it was thin yet tasted thick like molasses, it was extremely bitter with a strange after taste, still not sure if I liked it but the Thai tea is amazing). We talked for about a half hour, he told me how he had studied at Platsburg for one year and how on multiple occasions he had been to the US for various confrences and lectures, most in NY some in neighboring states. Dr La then took me to three other operations he was preforming that day. The first was a biopsy of possible esophogus tumor in a woman in late adult hood, he explained that the sample would be sent to pathology for testing before any other actions were taken. The next was the removal of a matastisis in the upper section of the throat, for this he used a new laser which the hospital had recently bought for 80 thousand baht, double the price of the previous one the used, he told me how this new one was much better because it could cut with a flat laser or a cureved laser insteas of just a dot pointDr La then treated me to lunch in the hospital caffeteria and we talked about Thail health care. He explained that almost all health´╗┐ care in Thailand is free. The hospital we were in, he explained, is half private and half public, the public portion is completly free for everyone, the private section varries depending on person and case, but even those who need to pay do not need to pay very much. He told me how he liked working in ENT because he was able to help many people but he was sad because they could only truly help 50% of the paitents, he said this is beacuse many of the paitents wait until the disease has already progressed very far before seeking medical help; he said if they were to get help right away then the figures would be as high as 80% people saved.
After lunch he took me to his last surgery, it was to last the rest of the day. The paitent was a middle aged man who had a tumor on the left side of his neck and would also be havinga mandibalectomy. the surgery began with the mans skin being cut from the bottom of his jaw to his collar bone, then pealed back to reval the muscles of the neck. It was amazing I wish I could have taken pictures. It took over half an hour to burn all of the tumor off, the entire left lymphnode was removed. Then the really fun part began. Dr La took a small chisle and hammer and pounded away at the jaw just to theleft of the midline, and after some work finally pulled the entire right side of the mandibal free, teeth and all. I was one of the coolest things I’ve ever seen. Dr La then began drilling in various metal rods and plates to get ready for reconstruction before sewing the man back up. I was not able to see the completed surgery as I had to leave, but I am sure the man was not going to be feeling good afterwards because not only did he have the tumor and his mandibal removed but he had reconstruction surgery done to his left feamur at the same time.