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Doctor's Consultation  by Dr. Iain Corness


Update October 29, 2016

Test for everything, Doc

“Were my tests OK?” is a query every doctor faces after sending a patient off for a blood test. Unfortunately, patients do seem to get a little confused about “blood tests”, or perhaps we need to explain them better.

Your ‘usual’ blood tests do not test for “everything”. The reason for this is simple. There are so many tests that can be done, that testing would go on for weeks if you wanted “everything” checked. (And let’s not ask the price!) For example, the Australian Royal College of Pathologist’s Manual of Use and Interpretation of Pathology Tests that sits on my desk lists 150 pages of tests that can be carried out. These include such items as a Reptilase Time, something I have never requested in 40 years of practice, or a red cell Galactokinase, ditto.

No, when we send you off for a blood test, we have to try and be reasonably specific, and sometimes even have to give the pathologists a clue as to where we are heading, and be guided by them as to some specific testing.

However, many times we are really just casting a ‘wide net’ to see what abnormalities we can turn up to use as a pointer towards the definitive diagnosis. One of the commonest is the “Complete Blood Count”, usually called a CBC, since we medico’s love acronyms, but remember this testing is in reality very far from “complete”.

The CBC does provide important information about the kinds and numbers of cells in the blood: red blood cells, white blood cells, and platelets. A CBC can help us evaluate symptoms such as weakness, fatigue, or bruising and even directly diagnose conditions such as anemia, infection, and many other disorders.

The CBC test usually includes the White blood cell (WBC) count as these cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells and normally fewer in number. When a person has a bacterial infection, the number of white cells can increase dramatically. There are five major kinds of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The numbers of each one of these types of white blood cells give important information about the immune system. An increase or decrease in the numbers of the different types of white blood cells can help identify infection, an allergic or toxic reaction to certain medications or chemicals, and many conditions (such as leukemia).

The Red blood cell (RBC) count is also part of the CBC. Red blood cells carry oxygen from the lungs to the rest of the body. They also help carry carbon dioxide back to the lungs so it can be exhaled. The red blood cell count shows the number of red blood cells in a sample of blood. If the RBC count is low, the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a risk that the red blood cells will clump together and block blood vessels (thrombosis).

Another part is the Hematocrit (HCT). This test measures the amount of space (volume) red blood cells occupy in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38 percent of the blood’s volume is composed of red cells.

Hemoglobin (Hb). Hemoglobin is the substance in a red blood cell that carries the oxygen. The hemoglobin level is a good indication of the blood’s ability to carry oxygen throughout the body.

There is also the Platelet (thrombocyte) count, which is an important part of the CBC. Platelets are the smallest type of blood cell and play a major role in blood clotting. If there are too few platelets, uncontrolled bleeding may be a problem, such as occurs in Dengue Hemorrhagic Fever.

So even though the CBC does test for many factors, there are still another 149 pages of tests that can be done! If you want to know your blood group, or your HIV status, you have to ask! So now you know!

Update October 22, 2016

The cost of living forever!

Woody Allen, a famous American comedian said, “I’m not afraid of dying; I just don’t want to be there when it happens.” Unfortunately, death is also inevitable, and as my dear old Mum used to say, “What am I doing here? I’ve passed my use-by date!” However, she certainly did make the most of her 94 years on terra firma, even winning a medal from the Duke of Edinburgh for her work in cataloguing wild flowers in the woods of Northern Scotland.

There are some special age-related problems, for those who live longer. A particular type of blindness called Age Related Macular Degeneration diminishes the eyesight to be lucky to identify three fingers at 2 meters. And we don’t have a fix-it right now, but we’re working on it.

Another disease prevalent in the older age group is Osteoarthritis. Hips and knees just ‘wear out’. We have invented artificial joints that do fairly well, but they only last about 15 years, so if you’re planning to reach 100, better wait till you’re 85.

Of course cancer is on this list. Cancers are primarily a condition of aging. After so many years of functioning properly, some of the cells just ‘wear out’ and an abnormal situation occurs. Without the checks and balances in the body systems, overgrowth of cellular tissue can turn into a malignant cancer.

So what about Dementia and Alzheimer’s Disease? Aging of the brain producing a slowing down of cerebral function.

Now all I have to do is get my brain hot-wired into a wireless network and I can meet the world head on, but we’re not quite there yet, so we (you and me) have to retain as much cerebral function as we can. And it turns out that it is not all that difficult.

We were always told that the one organ of the body that could not reverse the wasting process was the Central Nervous System. Once it started to fail, that was it. Dementia was just around the corner.

That view has recently been challenged and the results are comforting, to say the least. Experiments have been carried out that showed that by inducing stress in an animal resulted in chemicals being released. This on its own was nothing new, but what was new was the fact that some of these chemicals produced a difference in the brain’s anatomy! The idea that the brain could not change was incorrect! It could be ‘short-circuited’ resulting in a new wiring pathway.

In turn this has led to much research into the effects of stress and its reversal, and then on to Alzheimer’s Disease (if I have remembered to spell it correctly)! And if it were possible for its reversal too!

Returning to the research, we have shown that stress can physically damage nerve cells used in storing memory. We have also found that mindless watching of the goggle-box also produces a decline in brain function. In fact the numbers are more worrying than that. It has now been found that people with no stimulating leisure activities, and who are couch potatoes instead, are nearly four times more likely to develop dementia compared to those people who have leisure stimuli and do not waste hours in front of the TV.

Taking that a step further, and turning the scientific data around to be useful, it has been found that in being the converse to the couch potato, intellectually stimulating leisure activities had a ‘protective’ effect for the brain and its capabilities. What is more, they have also found that if you are doing a job you enjoy, then this was again protective, but a dull job with no stimulus or challenge was another way to dementia.

Do we have to take up chess tomorrow? No, because in place of intellectually stimulating hobbies, it has been found that physical exercise itself stops memory loss and stimulates growth of nerve cells.

Another protective factor appears to be marriage! Those who have never married have twice as high an incidence of dementia than those who are married. So there you are, rather than say that your wife is driving you insane, it appears that she is driving you towards sanity instead.

(I don’t believe it!)

Update October 15, 2016

Rover the Wonder Puppy Part 2

Readers may remember that last week I had the pre-op examination from Dr. Somchai (Bangkok Hospital Pattaya) to see if my ophthalmic status was such that it would be possible for me to have SuperSight surgery. After his clearance I returned to see him, saying, “Let’s do it!”

Let me assure you that was no throw-away decision. Like all of us, to have someone tampering with our eyes is frightening. Are Labradors and white sticks our futures? Is it painful? Is it dangerous? Has he done many of these operations? What is the success rate? What is his success rate? These were all the questions I asked of Dr. Somchai.

Let me assure you that the future does not include tins of dog food and tripping over kerbs. The satisfaction rate for SuperSight Surgery is over 99 percent. The missing one percent is people who found they still felt better with reading glasses for close work, even though middle distance and far distance were now fine.

Dr Somchai has now performed the SuperSight surgery over five thousand times and is considered the world leader in this technology.

On the morning of the op I presented myself to Dr. Somchai’s rooms (2nd floor) where Nurse Wanida was waiting and a brief check was made, including Blood Pressure (which was higher than usual, showing that despite my medical knowledge and faith in Dr. Somchai, there was natural apprehension).

Financial paper warfare was next and consent forms to be signed and I was taken to my room to change into hospital PJ’s, and where I used my reading glasses for hopefully the last time, to read the paper (Pattaya Mail, naturally).

At the appointed hour, a porter and a nurse arrived with a wheelchair. Down to the second floor and the maze of operating theatres and change into sterile SuperSight PJ’s. There was no turning back by then!

The ophthalmic operating theatre is dominated by a recliner chair, similar to a dental one, where you lie horizontal and are covered with sterile drapes. Light tethers on the arms remind you not to rub your nose during the op!

All this time, Dr. Somchai was there, explaining each step, administering anesthetic and ensuring there is no sensation from the cornea.

It is actually quite weird as when he is actually inside your eye, there is no pain, but you know he’s there as he liquefies the old lens and prepares the capsule for the new lens.

When the time comes for the replacement lens it was brought out from its sterile container and Dr. Somchai then began the exacting work of placing the lens inside the eye, while I lay there, concentrating on looking straight up and not moving the eye.

He told me that the operation on the first eye was over and I was then re-draped, leaving the left eye prepared for the same procedure of removing the old lens and inserting the new SuperSight one. Each eye had taken about 30 minutes and I was then taken into the recovery area, a compulsory wait to make sure I was otherwise fine.

Very shortly, Dr. Somchai’s happy face appeared and assured me that everything had gone according to plan and I could go back to the room.

With so many eye drops it was difficult to know how my vision was going to be, and having been given dark glasses to wear, it was not possible to judge, and I just fell asleep, glasses and all.

Waking at 6 p.m. I picked up the TV remote, which I could read for the first time in years, and flicked through the channels. The reception was good and my vision was not bad, but I had been warned not to try and judge the acuity for later.

By 9 p.m., after another sleep, I turned the TV on again. Wow! Clear, no blurring, and sharper picture than I was used to before.

Dr. Somchai did warn me that some patients experience a headache post-operatively, and simple paracetamol could be taken. Quite honestly I did not have any headache, but I was questioned by the attendant nurses to ensure that I was OK.

Again I slept well that evening and in the morning was taken to Dr. Somchai’s rooms again for a final check. Everything was fine and I was given my appointment slip for the final check in one week.

In the meantime I have eight pairs of glasses in my top drawer which I will never need again. Thank you Dr. Somchai.

Update October 8, 2016

Labradors and white sticks

I have always said that getting older isn’t necessarily fun, but it still beats the alternative. I have been very lucky to inherit some of my mother’s genes who lived to be 94, as opposed to the male side of the Corness family, which, until me, nobody had ever seen their 57th birthday! I have to admit that as 57 grew close I was taking my pulse very frequently!

Anyway, 57 has been and gone and to make that birthday even more memorable, it was celebrated on the stage of the Malibu Cabaret (Soi Post Office, but long gone now) with the cake brought out by Ladyboy entertainers.

However, there has been a gradual decline in one of my senses, which began as a nuisance until eventually I could not ignore it any longer. My vision was deteriorating!

Medically we call it Presbyopia, the shortsightedness of aging which happens to most people as they get to the mid-40’s. You find it difficult to read the paper without holding it at arms length. Eventually you run out of arms!

In poor light, it becomes very difficult to read maps, for example. I remember standing in front of my car’s headlights trying to read a map, but even with better illumination I still ran out of arms.

I played around with reading glasses for a while. The simple (read ‘cheap’) readers you can buy from market stalls. Not really recommended, but I’ve never been one for strictly following the rules.

It was then that I started to have difficulties driving at night. Those of you who know me will understand just what a problem this was becoming. Driving for me is not going from A to B, but is an art form. I have been besotted by motor cars ever since age 11. As an aside, I notice Evan, my newly turned 11 year old son sitting in the passenger seat holding an imaginary steering wheel as we drive along – perhaps it is genetic.

But back to the vision. It was street signs first, and when out doing house calls at night, this was a big problem. My big son in Australia (who grew to be 6’ 6") had to come with me to assist in navigation – he could read the signs!

I tried glasses, but kept on losing them, sitting on them, dropping them into the engine bay of the race car. Glasses were not the answer.

My friendly optometrist suggested contact lenses. My father had had a brief affair with contacts (the hard ones in those days) but was never able to wear them satisfactorily, but the technology had progressed and soft contacts were on the scene. With two contact lenses installed by the optom I went out that night with big son. “I can read the street signs,” I remember me saying to him. “And I can read the numbers on the busses!”

The only problem with the contacts was putting them in each morning. They seemed to have a mind of their own, and more than one lens committed suicide on the bathroom tiles.

I wore contacts from 1992 until this year, but I began to notice my distance vision was deteriorating. I began wearing glasses again with the contacts. What is worse, one eye was worse than the other, and night driving was becoming hazardous. I had to take the sun film off the windows of the car, or drive with the windows down. I couldn’t judge distances. It was time for me to be a bit more responsible!

Time for me to consult one of my colleagues in the Ophthalmic specialty, who I thought could give my eyes the quick once-over, prescribe stronger contacts and I would be away. That was not how it was to be.

I consulted Dr Somchai Trakool-Satian who spent an hour testing my eyes – corneas, retinas, pressures, lenses, the lot. He had good news and bad news. My pressures were fine, retinas likewise, but I had cataracts, and if I wanted to throw all my glasses away, the answer was SuperSight surgery. I went away to consider my options and returned to say, “Let’s do it!”

(The tale of my SuperSight will continue next week.)

HEADLINES [click on headline to view story]

Test for everything, Doc

The cost of living forever!

Rover the Wonder Puppy Part 2

Labradors and white sticks