One of the reasons why surgery appeals to me is the clinical input that makes a difference in the treatment of patients. Often in surgical patients, one decides whether to operate or not based on the clinical signs that the patient has. No test, X-ray or blood test, can make you change your mind once there are some key clinical signs present.

“Clinical” means the features that are found on questioning the history of the illness and found on direct examination of the patient at the bedside, without input from investigations/tests.

One such patient came at 11 o’clock one evening with abdominal pain. He had had a car accident four days prior to coming. He complained of abdominal pain but scans done at another centre (it’s always another centre ;-)) were normal. Abdominal examination revealed tenderness. There is pain in the abdomen when touched during examination. There was a sign called “guarding” present. That means that the abdominal muscles contract invountarily when the abdomen is pressed lightly. It is a sign that there is an irritant inside the abdominal cavity. This irritant is usually the presence of inflammation in the inner lining of the abdominal cavity (peritoneum), called “peritonitis”. There is also tenderness and guarding when there is pus, blood or other materials such as bile in the abdominal cavity. It’s an alarm signal for surgeons.

Some people come with abdominal pain and, on examination, these signs are found. I tell them they need an operation. What they want to know is how sure I am. They want to see some tests before they are convinced. This is important: when the surgeon has examined and decided that the signs are positive for appendicitis or some other cause of peritonitis, if all the tests are negative, surgery is still not avoidable. This is because no test can be as sensitive as the examining hand for peritonitis.

The patient who came with abdominal pain had peritonitis but he wasn’t convinced… until I took this X-ray:

So off to surgery…

So, the lesson for the day: trust your surgeon’s hands. Really.

I’m sure most people are aware what an ABSCESS is. It’s a collection of PUS in a space bounded by inflammatory tissue. The treatment is simple: the principle is, if there’s pus… drain it.

However, many people have not heard of a CARBUNCLE. A carbuncle is another type of soft tissue infection containing pus in the tissue space characteristically with inflammation in the surrounding tissue and numerous exit points for the pus. The most common site of a carbuncle is the back of the neck. This one is in the axilla (armpit). The patient is diabetic and the blood glucose control was very poor, probably due to the presence of infection.

Saucerization is the procedure of resecting all the pus, sinuses (the spaces containing the pus) and surrounding infected tissue until healthy, clean tissue is found. The wound is left open and dressed until healing occurs.

You might be surprised, and wonder, “Will such a big wound heal?” Yes! It will. The process is called “healing by secondary intention”. The body has a mechanism by which the space is filled by tissue, called “granulation tissue”. Once the space is bridged by the granulation tissue, skin tissue grows from the edges and covers the exposed granulation tissue.

Whilst it is still the Chinese New Year period, let me post a tutorial on how to make paper koi. Sorry, Lilian and jonzz for being late… nevermind, Chap Goh Mei is still eleven days away.

So here are the instructions:

1. Create a template like this one:

or click on the image to download an actual-size template.

2. Get an old CNY card and trace the shapes on it using the template an a guide. Preferably, the body should be made with the parts of the card that are adorned with colourful decorations. After that, cut the fish shape out from the card.

3. Here’s the tricky part… a video will show you how to fold the cut-outs into koi. Ward 2 sister demonstrates:

4. Add the eyes by sticking two black beads on the head with glue. Then stick onto the wall with cellophane tape.

Have fun!

Wishing you and your family a great Chinese new year of the pig!
May all your endeavors in the new year be blessed..

Traditionally, we bring a gift of two mandarin oranges for family and friends when we visit for Chinese New Year. Here are a pair of oranges for you….