Dad got 13th place in the senior veterans’ category in the 12-hour walk around the Esplanade in Penang. Congratulations, Dad!
OK, who’s got a cooler Dad, huh?
Walk the talk.
My dad promotes a healthy livestyle at a Ministry of Health’s Health Clinic.
Note: an injury of the small bowel… not a small injury of the bowel.
A man was involved in a head-on collision between his car and an on-coming lorry at 6 pm. His abdomen struck the steering wheel. He had received outpatient treatment and went home. He came to hospital the next morning with severe abdominal pain. Examination revealed a septic, dehydrated man with signs of peritonitis. He was given lots of fluids and a laparotomy was performed.
These were what I found:
1. A hole in the intestine.
2. A hole in the “mesentery”, that layer of membrane and fat attached to the intestine.
Bad news: multiple bowel injuries. I wonder which injury will be more likely to give me sleepless nights post-op.
The hole in the intestine (number 1) was pouring intestinal contents into the peritoneal cavity. That’s bad. It’s very contaminated. That causes a life-threatening infection in the abdomen. The hole was repaired with stitches. Ok… looks good. There’s a risk of stitches breaking down and spilling the intestinal contents again but small bowel heals fairly well compared to large bowel.
Now, the hole in the mesentery (number 2) is a bigger problem… the mesentery carries the blood supply to the particular segment of intestine it’s attached to. If there’s a big tear like this one, the bowel’s blood supply is cut of. That’s bad too. Soon, that segment of bowel will die and an even bigger source of infection will open up. The dying segment was removed (segmental resection), the open ends were brought together, and joined with stitiches (primary anastomosis). This is going to be the bigger headache… because the risk of it leaking is higher than no. 1.
When will he pass wind? The longer he takes, the more anxious we’ll be getting.
It’s been 2 months since work on my garden started. Some progress has been made :-). I’m happy to report that the grass has grown a bit. The most enjoyable part is seeing flowers bloom in the garden. The flowering plants were brought by my mother from Bukit Mertajam. Thanks, mom!
Greener grass.
Anthuriums: the first flower to bloom in the garden.
Japanese roses. Easy to grow. These spread really fast.
Roses are red…
This flower has a attracted an admirer. I think it’s a male mosquito feeding on the plant’s juice. I’m no entomologist.
The mandatory curry-leaf plant. A bit stunted?
The answer to today’s quiz is pseudomelanosis coli, or more commonly, just melanosis. It’s caused by abuse of laxatives. More specifically, it’s the prolonged use of a type of laxative called senna or senokot.
You see, this patient was having constipation. He took senna over-the-counter habitually. Over a long period, he developed the patchy pigmental deposits in the lining of the colon which is characteristic of melanosis. It is actually harmless. Treatment is directed at the cause of the constipation. Or educating the patient regarding the normal expectations of healthy bowel movement.
Here is an article about melanosis coli on medicinenet.com. And here are some more photos of melanosis coli.
These laxatives are herbal preparations that have been in use for hundreds of years. There is some evidence that it can cause tumours in animals but there’s no data for human colon cancer. Having a drug that had been used for long time doesn’t mean that it’s safe. Neither does it’s herbal origin make it safe. Consult your friendly neighbourhood doctor when you have constipation 
