R2D2 visits Thailand
Remember R2D2? If you’ve forgotten, remember Luke
Skywalker and the Star Wars movies? Of course you do. Now while the robot
R2D2 is gathering dust in some Hollywood storage space, another type of
robot arrived in Thailand a couple of weeks ago, and it was that which
jogged my memory.
This new robot is called RoboDoctor,
and is involved in one of the latest types of care delivery, and that is
called ‘tele-medicine’. This advance in medicine should not be confused
with ‘robotic’ surgery, where the surgeon controls a robotic ‘arm’ which can
carry out very fine tasks. Tele-medicine consists of connecting two doctors
(in most cases) to be able to discuss with each other the likely diagnosis
and subsequent treatment of a patient.
The following true scenario is a
wonderful example of tele-medicine at its most basic and this genuinely
happened in Australia. A doctor in the outback was called to see a patient
with a head injury and it became obvious that there was a bleed inside the
skull. If left untreated or unchecked the patient lapses into deeper and
deeper unconsciousness and then dies.
The answer to this problem is called
‘trephining’ or making a ‘burr hole.’ By drilling through the skull, the
blood can be removed and the pressure is taken off the brain. This
procedure dates back to BC times, and museums all over the world have
examples of primitive trephines. However, the museum cannot tell us how
many were successful procedures! (Operation a success but the patient
There are a couple of spots in the
skull where it is safe enough to drill, but exactly where? A GP out in the
scrub would hardly know this. And now we come to the drama. The outback
doctor had a household electric drill in his home tool kit and rang a
specialist in one of the capital cities, who described to him just where to
drill - over the phone. He drilled, the blood was released and immediate
problem averted. Heroic stuff! And yes, it was successful and both doctor
and patient were heroes in my book.
Now back to the RoboDoctor in Thailand,
and Pattaya in particular, and further refinement of this tele-medicine
concept. Rather than just audio contact between two doctors, there is
visual contact as well. What is more, the robot can be moved in any
direction and directed wirelessly by the treating doctor at the bedside, but
this can also be done by the consultant specialist who may be many
kilometers away, using Wi-Fi connectivity. Close up magnification can be
done, the visual frames stopped and guidelines drawn on the image on the
screen. For the patient, it is almost as if they are having a consultation
with (in this case) a specialist neuro-surgeon at the bedside.
This tele-medicine allows ‘remote’
examinations to be done, which could, for example, be a doctor doing a
‘virtual’ ward round in the middle of the night. And although I called it
“virtual”, it is actually real-time, just as an examination is real-time.
The robot comes equipped with a
powerful lens that sees better than a human eye and the high-tech device can
hold a patient’s electronic records and tests such as EKG’s, X-Rays and
Echocardiograms, and access them immediately.
One surgeon who is using a RoboDoctor
is Ivar Mendez, head of neurosurgery and of the medical facility's brain
repair center in Canada at the Halifax QEII hospital. He said patients
quickly become comfortable speaking with the robot and forget it's a piece
of technology examining them.
“I strongly believe this technology is
part of the future of medicine. It will bring the expert to the patient
anywhere in the country. Robots will not replace physicians,” Mendez said.
“Rather, the robots help provide universal health care ensuring that even
individuals in remote communities will have access to specialized care.”
That was the Canadian experience, and
that is now being replicated here, with the Bangkok Medical Center, Bangkok
Hospital Pattaya and Bangkok Hospital Hua Hin all linked up through
RoboDoctors. The future is here, now!
Life as a novice doctor
Having now been a doctor for over 40 years, I have begun
writing another book. Not another one on life in Thailand (Farang
and Farang The Sequel), but snippets of my medical life - highs,
lows, funny bits and sad bits. Here is an extract from one of the early
After I graduated in
the UK, like all new doctors, you have to do a year’s internship in a
hospital. In the UK, this is called your pre-registration year. In other
words, you work under supervision to ensure you kill as few patients as
For the brand new
doctor, with a brand new shiny name badge, this is a fairly trying time, and
a year in which you find out just how much you don’t know. For me, I was
quite confident that I would be able to diagnose the seventh beta cell
adenoma of the pancreas ever found in the world, but I had no idea what to
do for tonsillitis in children, of which there are probably seven million
cases every month. The undergraduate education system had many
It is at this time
that the tyro doctor has to bow to superior knowledge - not the specialist
doctor to whom you are seconded, but to the nursing sisters in charge of the
wards you work in. For me that was ‘Unders’ (Sister Underhill) and ‘Robby’
(Sister Robinson). It was those two experienced ladies who successfully, I
might add, got me through the first six months of my ‘medical’
My first job every
morning was to take blood samples from the patients, after the requests left
by the more senior doctors, who did not have to take their own ‘bloods’.
One particular morning I grabbed my list and began collecting. Everything
was going well, until I had to take blood from Mr. Jackson. He lay there
quietly enough, and even though I was sure I had the needle in the vein, the
amount of blood issuing was very slight and very slow. However, I
persisted, as I did not want to admit to failure in front of Unders and
Robby. After 15 minutes I had enough blood for a sample and returned the
tubes to the Ward Sister’s desk. “How did you go with Mr. Jackson?” asked
Unders. “Very difficult and very slow, but I managed it,” I said proudly.
“Not bad,” said Unders. “He’s been dead for two hours.” After that
salutary lesson I always spoke to any patient from whom I was to extract a
Every week we had a
‘Grand Rounds’ where the entire medical and nursing team would visit each
patient in the medical wards. Around the bed would be (in order) the Senior
Consultant, the Senior Registrar, the Junior Registrar, the Senior House
Officer, the Junior House Officer (me), the Nursing Sister, the Charge Nurse
and then all the little nurses. The order was sacrosanct and obviously
steeped in medical history, because if I moved myself up the order while
walking to the next bed, I would be elbowed out by my superiors, and if I
dallied, and moved down the order, then the nursing staff would regroup
behind me and push me forwards.
It is rare to forge
long-lasting friendships as a junior doctor. You are only there for six
months before you move on to another teaching hospital for the second six
months. However, I did get quite friendly with one of the surgical team, a
Pakistani royal, Prince Siraj Ghazali.
When we were
registered on call on the same evenings, on those occasions it was my
pleasure to dine with the Prince. Hospital food is almost universally
dreadful, at any hospital I have worked in all over the world. Often I felt
that patients got better to escape the food!
Siraj had that Asian
charm, which he could turn on at will, and he would charm the hospital
cook. While the rest of the doctors ate mass produced slop, the Prince and
his friend would have a special table set up, complete with starched
tablecloth and partake of an English cook’s idea of a Pakistani curry. At
least it was better than the standard fare.
Can you ignore rectal bleeding?
Can you ignore rectal bleeding? Yes you can, but at a
huge personal risk. Not every case of rectal bleeding is from a pile
(hemorrhoid) that will settle. (And in fact, most do not.)
A very good friend of mine had a scare
a few weeks back with some rectal bleeding, but fortunately the cause was
found with a colonoscopy, the condition was amenable to surgery and he is
now over it. But it could have been the other way round. Never ignore
The rectum is the last portion of the
large bowel that ends just before the anus. Bleeding from this area can
herald a sign of a mild or life-threatening importance, which is why all
episodes of rectal bleeding must be investigated.
Depending upon how high up in the
gastro-intestinal tract is the cause of the bleeding, it may be seen as
black, tarry stools, maroon stools; bright red blood on or in the stool,
blood on the toilet tissue, or blood staining the water in the toilet bowl
bright red. Treatment can range from relief of symptoms and let Mother
Nature do the rest, to antibiotics, blood transfusion, or even surgery. It
all depends on the cause.
There are many potential causes,
including Hemorrhoids (piles) which are swollen rectal veins in the anal and
rectal area. They can cause burning, painful discomfort, as well as
bleeding. External hemorrhoids are small swellings that are easy to see and
quite painful; however, internal hemorrhoids are usually painless. A
feeling of incomplete emptying may be noted with bowel movements. Treatment
focuses on relieving these symptoms with the use of stool bulking agents and
softeners, and if necessary, removal of the bleeding piles.
Rectal fissure is another. This is a
tear in the lining of the rectum caused by the passage of hard stools, which
can lead to mild rectal bleeding of bright red blood. Exposed nerves and
vessels result in moderate to severe pain.
Diverticulosis, those little pockets on
the bowel wall, can also bleed. The stools are dark red or maroon. Pain is
usually absent but surgery is required in up to 25 percent of these
Bloody diarrhea is often seen in
Bacterial dysentery, which we have all had to a greater or lesser degree.
Responsible organisms include Campylobacter jejuni, Salmonella, Shigella,
Escherichia coli, and Clostridium difficile. A most unsavory bunch! The
treatment depends upon the organism, but generally intravenous fluid
replacement and an anti-spasmodic and broad spectrum antibiotic will bring
this under control.
Another common cause of rectal bleeding
is Inflammatory bowel disease especially in young adults - typically those
younger than 50 years of age. Bleeding occurs in small to moderate amounts
of bright red blood in the rectum, usually mixed in with stool and mucus.
Associated symptoms include fever and abdominal cramps. This condition
generally settles with steroids.
Of course, the one that everyone
worries about is bowel cancer. We lump these together under the general
heading of Tumors and Polyps. Polyps bulge out from the lining of the
colon. Bleeding occurs when large polyps develop. They can be hereditary,
and are usually harmless, but some types can be pre-cancerous.
Both benign and malignant tumors are
frequently found in the colon and rectum. Those people older than 50 years
are most affected; however, tumors can be found in younger people. It
should also be noted that less than 20 percent of people with tumor or
polyps will have rectal bleeding. However, when bleeding does occur, it is
usually slow, chronic, and minimal. Diagnosis requires careful evaluation
Rectal bleeding from a traumatic cause
is always a critical concern. Rectal damage from a gunshot wound or foreign
body insertion can result in extensive infection or rapid and fatal blood
And yes, there’s more! A common source
of bleeding is hemorrhage from the stomach or duodenum. This can occur
after someone has swallowed a foreign body that causes injury to the stomach
lining or bleeding stomach ulcers.
The list does go on, but these
conditions are rare; however, the message is that rectal bleeding must
always be investigated. Never ignore rectal bleeding!
Have you had the spring cough?
Have you had the spring cough yet? If not, think
yourself lucky, just about everyone else has had it. And it isn’t one of
those coughs which goes away in a couple of days, patients are saying it
takes at least a couple of weeks. Or even longer.
There are many reasons for epidemics
such as these, and most occur with the change of seasons, hot to cold, cold
to wet and so forth, but with the vast majority, the common carrier of the
bug is the human race. This time we can’t blame an innocent mosquito!
Yes, we are the ones who go to work and
spread our germs to the office, exploding an aerosol of potentially
debilitating diseases into the air, every time we cough. This is the
commonest way of transferring the bugs, by what we call droplet infection.
Every droplet capable of carrying thousands of microbes, each one looking
for another human to infect. You. Or even me. In our household, my young
son brought it home from school, passing it on to his elder sister and now
to me. Thank you so much, Evan.
The latest bout has been a form of
URTI, which is our acronym for Upper Respiratory Tract Infection. This is
inflammation of the bronchus, that part of your breathing tube to the lungs
before it splits to become the right and left bronchus. The medical name is
therefore “Bronchitis”. The clue is in the ending - “itis” which generally
means inflammation and / or infection. Thus you can get Appendicitis
(inflammation of the Appendix) and Pharyngitis (inflammation of the
pharynx), Laryngitis (inflammation of the larynx) etc., etc.; you get the
Infection and irritation of the
breathing tubes is, as we said in the beginning, very common. The most
usual predisposing cause is, however, our old friend cigarette smoking! If
you don’t believe that cigarette smoke is irritating, try letting cigarette
smoke waft into your eyes and see how they will sting and water. Your
sinuses and bronchi do just the same! Once the irritation begins, the
mucous lining becomes swollen, and it becomes easier for the germs to take a
With Bronchitis, it generally begins as
a slight irritation deep in the back of your throat. There can be some
soreness as well, even on swallowing. Unchecked this develops into a
‘productive’ cough, with loads of thick, tenacious gunk being coughed up,
which we refer to as ‘sputum’.
One of the signs and symptoms your
doctor will want to know is, “What color is your sputum?” This gives us a
chance to see if your cough is from an irritation or infection. If you are
bringing up large lumps of yellow or green glue then you have an infection,
but if the mucous is clear then you probably do not harbor a nasty bacterium
in your throat, but an equally nasty virus. If however, the sputum is red
and bloodstained then you may have burst a little blood vessel in the throat
- or of course, this could be an early sign of lung cancer but don’t panic
If the sputum you are coughing up is
thick, green and gooey, this is fairly suspicious of a bacterial infection,
and sometimes we will attempt to “grow” the bug to identify it. No, this is
not for germ warfare, it is just so that we can feed the bug some different
antibiotics to see which ones exterminate the bug best. This is a much more
accurate way of choosing the correct antibiotic, than selecting ones by the
pretty color they are on the pharmacist’s shelves. And I don’t go along
with trotting down to local pharmacy and getting “some antibiotics”. That’s
how we end up with antibiotic resistance.
If you have gone over a week and your
cough is showing no sign of letting up then it really is time to line up
with all the other coughers at the outpatients department. Just make sure
you can describe the color of your sputum!
Remember that if you are a smoker, the
chances of the cough lasting longer are much higher, as well as your being
more likely to catch the cough from someone else.
Cardiac unit diet - fast weight loss?
I met an old friend at a networking evening this month.
I hardly recognized him - he had lost 45 kg in weight. “Did you have
surgery?” I asked, thinking he might have had the sleeve gastrectomy which
is the latest “keyhole” surgical procedure for obesity. But no, diet was
all he had done.
Now I do not know if it was this
particular diet I have published here, but I do know that this one works.
It is not strictly a “diet”, it is more correctly a “weight loss” program.
One friend of mine had dropped 15 kilos
in two months with this diet that obviously worked! This is put forward as
a seven day diet, and although I am not always in favor of ‘crash’ diets,
this one does merit some study. It is reputedly from Sacred Heart Memorial
Hospital and is used in their cardiac care unit for overweight patients to
lose weight prior to surgery.
It states the first no-no’s as being
bread, alcohol, soft drinks, fried food or oil. Agree totally, though
probably half of you have already decided it’s too hard!
After that there is a concoction called
Fat-Burning Soup (FBS) which you make up and keep in the fridge. You gobble
FBS any time you feel hungry and have as much as you want. You are also
advised to drink plenty of water suggesting 6 - 8 glasses a day along with
tea, coffee, skim milk, unsweetened juice or cranberry juice.
The physiology of hunger works that
when the stomach is empty, messages are sent to the brain to send down
food. Fill the belly with non-fattening food and the hunger pangs will be
less, but the weight does not go on.
Here is the recipe for the Fat-Burning
4 cloves garlic
2 large cans crushed tomatoes (810gms)
2 large cans beef consommé
1 packet vegetable soup
1 bunch spring onions
1 bunch celery
2 cans French beans (or fresh)
2 green capsicum
1 kg carrots
10 cups water
Chop all veggies into small pieces.
Boil rapidly for 10 minutes stirring well and then simmer until veggies are
tender. Add water if necessary to make a thinner soup.
Now the other downside to dieting is
food boredom. A week of FBS, water and cranberry juice will sap the resolve
of most overweight people, so what this diet does is allow you to add
different items on a daily basis. Here are the suggestions.
Day 1, any fruit except bananas. Eat
only soup and fruit.
Day 2, all vegetables. Eat as much as
you like of fresh, raw or canned vegetables. Try to eat green leafy
vegetables. Eat vegetables along with soup.
Day 3, eat all the soup, fruit and
veggies you want today. If you have not cheated you should have lost approx
3 kg. (If that is so, it is an amazing loss in three days - but keep going
Day 4, bananas and skim milk. Eat at
least three large bananas and drink as much skim milk as you like today.
Eat as much soup as you want as well. Bananas are high in calories and
carbohydrates, as is the milk but you will need the potassium and
Day 5, beef and tomatoes. You may have
600 gm of beef or chicken (no skin) and as many as 6 tomatoes. Eat soup at
Day 6, beef and vegetables. Eat to
your hearts content of beef and veggies. You can even have 2-3 steaks
(grilled) if you like with leafy green vegetables. No baked potato. Be
sure to eat soup at least once.
Day 7, brown rice, vegetables, fruit
juice. Be sure to eat well and eat as much soup as you can.
By the end of day 7, if you have not
cheated, you should have lost 7 kg. The theory is good, but I caution
against losing too much, too soon.
If your weight loss needs are greater
than 7 kg, then continue for another week, but I do not recommend much
further than two weeks at one time, and do not repeat the program within
And if all else fails - then it’s